Introduction
Materials and methods
Results
Clinical features
Case | Age (years)/sex | Clinical presentation | Radiologic findings | Location | Treatment | Follow-up (months) | Status |
---|---|---|---|---|---|---|---|
1 | 66M | NA | Abdominal occupying lesion | Small intestine | Laparotomy | 60 | ANED |
2 | 71F | Gastrointestinal bleeding | Abdominal occupying lesion | Stomach | Laparotomy | 143 | ANED |
3 | 55F | Abdominal discomfort | Occupying lesion between liver and stomach | Stomach | Laparotomy | 103 | ANED |
4 | 42M | NA | Abdominal occupying lesion | Small intestine | Laparotomy | 128 | ANED |
5 | 50F | Gastrointestinal bleeding | Occupying lesion in the head of pancreas: GISTs? | Duodenum | Laparotomy | 128 | ANED |
6 | 71F | Incidental findings during examination for cystic disease of kidney | Cystic lesion in the tail of pancreas | Stomach | Laparotomy | 123 | ANED |
7 | 35F | Abdominal mass | Ovarian cyst | Small intestine | Laparotomy+ Imatinib | 39 | ANED |
8 | 73F | Incidental finding during examination for appendix mucinous adenocarcinoma | Abdominal malignant tumor: GISTs? | Small intestine | Laparotomy | 4 | DUD |
9 | 31F | Gastrointestinal bleeding | Abdominal occupying lesion | Stomach | Laparotomy | 75 | ANED |
10 | 72F | Abdominal mass | Cystic lesion between liver and stomach: GISTs | Stomach | Laparotomy | 79 | ANED |
11 | 61F | Incidental finding during physical examination | Abdominal cystic lesion: GISTs? | Stomach | Laparotomy | 36 | ANED |
12 | 62M | Abdominal pain | Abdominal cystic lesion: GISTs? | Stomach | Laparotomy | 63 | ANED |
13 | 58M | Abdominal discomfort | Abdominal occupying lesion | Stomach | Laparotomy | 51 | ANED |
14 | 47M | Gastrointestinal bleeding | Abdominal occupying lesion | Duodenum | Laparotomy | 59 | AWD |
15 | 61F | NA | Abdominal occupying lesion | Stomach | Laparotomy | 36 | ANED |
16 | 68M | Abdominal discomfort | Abdominal occupying lesion | Stomach | Laparotomy + imatinib | 45 | ANED |
17 | 57M | Abdominal pain | Diverticulum or GISTs | Small intestine | Laparotomy | 19 | ANED |
18 | 61F | Incidental finding during physical examination | Ovarian chocolate cyst | Omentum | Laparotomy | 30 | ANED |
19 | 45M | NA | Abdominal occupying lesion | Small intestine | Laparotomy | 66 | ANED |
20 | 64M | Incidental finding during physical examination | Pelvic occupying lesion | Small intestine | Laparotomy + imatinib | 92 | ANED |
Pathologic findings
Case | Size (cm) | Focality | Cystic contents | Sectioning | Cellularity | Cellular type | Mitosis (/50 HPF) | Cellular atypia |
---|---|---|---|---|---|---|---|---|
1 | 15 | Unilocular | Dark bloody necrosis debris | NA | Moderate | Epithelioid | 0 | Mild–moderate |
2 | 12 | Unilocular | Dark brown fluid | Grey/white | Moderate | Epithelioid | 3 | Mild–moderate, partially severe |
3 | 8 | Multilocular | Light yellow clear fluid | Grey/red | Moderate | Epithelioid | 2 | Moderate–severe |
4 | 8 | Unilocular | Dark bloody necrotic debris | Grey/white | Moderate | Spindle | 0 | Mild–moderate |
5 | 10 | Unilocular | Dark brown fluid | Grey/white | Moderate | Spindle | 1 | Mild–moderate, partially severe |
6 | 7 | Unilocular | Dark red fluid | Grey/red | Moderate | Spindle | 2 | Mild–moderate |
7 | 9 | Unilocular | Dark bloody necrotic debris | Grey/brown | Moderate | Spindle | 2 | Mild–moderate |
8 | 8 | Unilocular | Grey–green turbid fluid | Grey/red | Moderate | Spindle | 1 | Mild–moderate |
9 | 8.5 | Unilocular | NA | NA | Moderate-Condense | Spindle | 1 | Moderate |
10 | 16 | Unilocular | Grey–red turbid fluid | Grey/white | Moderate | Epithelioid | 0 | Moderate–severe |
11 | 12.5 | Multilocular | NA | Grey/white | Moderate | Spindle | 1 | Mild–moderate |
12 | 20 | Multilocular | Dark red fluid | Grey/white | Moderate | Epithelioid | 0 | Moderate, partially severe |
13 | 13.5 | Unilocular | Brown fluid | Brown | Moderate | Spindle | 0 | Mild |
14 | 12 | Unilocular | Dark red necrotic debris | Grey/white | Moderate | Spindle | 2 | Mild–moderate |
15 | 13 | Unilocular | NA | NA | Moderate | Epithelioid | 11 | Moderate |
16 | 15 | Multilocular | Dark bloody necrotic debris | Grey/white | Moderate | Spindle | 1 | Mild–moderate |
17 | 9 | Unilocular | Dark red necrotic debris | Grey/brown | Moderate | Spindle | 0 | Moderate–severe |
18 | 8 | Unilocular | NA | NA | Moderate | Spindle | 8 | Moderate |
19 | 14 | Unilocular | Dark bloody necrotic debris | NA | Mild | Spindle | 1 | Moderate |
20 | 13 | Multilocular | Dark bloody serous fluid | Grey/red | Moderate | Spindle | 0 | Mild–moderate |
Case | Malignant parameters | Malignancy | NIH criterion | CD117 | Desmin | DOG-1 | CD34 | SMA | S-100 | Mutational status |
---|---|---|---|---|---|---|---|---|---|---|
1 | No | Nonmalignant | High | Pos | Neg | NA | Pos | Pos | NA | None in c-kit or PDGFRα |
2 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Neg | Pos | Neg | None in c-kit or PDGFRα |
3 | Infiltration of muscularis propria and vessels | Low | Intermediate | Pos | Neg | Pos | Pos | Neg | Pos | None in c-kit or PDGFRα |
4 | No | Nonmalignant | High | Pos | Neg | Pos | Pos | Neg | NA | None in c-kit or PDGFRα |
5 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Pos | Pos | Pos | c-kit exon 11 Y568S, DEL569-573 |
6 | No | Nonmalignant | Intermediate | Pos | Neg | Pos | Pos | Neg | Neg | c-kit exon 11 V559D |
7 | No | Nonmalignant | High | Pos | Neg | Pos | Pos | Pos | Neg | None in c-kit or PDGFRα |
8 | Muscularis propria infiltration | Low | High | Pos | Neg | Pos | Pos | Pos | Pos | c-kit exon 11 L576P |
9 | No | Nonmalignant | Intermediate | Pos | Neg | NA | Pos | Neg | Neg | c-kit exon 11 DEL559-561 |
10 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Pos | Neg | NA | c-kit exon 11 V559D |
11 | No | Nonmalignant | High | Pos | Neg | Pos | Pos | Neg | NA | c-kit exon 11 DEL557-558 |
12 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Pos | Neg | Neg | PDGFRα exon 18 D842V |
13 | No | Nonmalignant | High | Pos | Neg | Neg | Pos | Neg | NA | PDGFRα exon 18 D842V |
14 | Infiltration of mucosa and muscularis propria | Low | High | Pos | Neg | NA | Pos | Pos | Neg | c-kit exon 11 Y553D, DEL554-572 |
15 | No | Nonmalignant | High | Pos | Neg | Pos | NA | Neg | NA | None in c-kit or PDGFRα |
16 | No | Nonmalignant | High | Pos | Neg | Pos | Pos | Neg | Neg | c-kit exon 11 V559D |
17 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Pos | Neg | Neg | c-kit exon 9 INS502-503 |
18 | Severe nuclear atypia | Low | High | Pos | Neg | Pos | Pos | Neg | Neg | None in c-kit or PDGFRα |
19 | No | Nonmalignant | High | Pos | Neg | NA | Neg | Pos | NA | None in c-kit or PDGFRα |
20 | No | Nonmalignant | High | Pos | Neg | NA | Neg | Neg | Neg | None in c-kit or PDGFRα |
Treatment and follow-up
Comparison between cystic and solid GISTs
Cystic (n = 20) | Solid (n = 200) |
P
| |
---|---|---|---|
Age (years) | 59.5 (66–73) | 60 (19–84) | 0.554 |
Sex | |||
Male | 9 | 116 | 0.263 |
Female | 11 | 84 | |
Location | |||
Stomach | 10 | 117 | 0.462 |
Non-stomach | 10 | 83 | |
Cellular type | |||
Spindle | 14 | 175 | 0.071 |
Non-spindle | 6 | 25 | |
Size (cm) | 9 (7–20) | 12 (7–20) | 0.056 |
7–9.9 | 8 | 102 | 0.601 |
10–14.9 | 8 | 70 | |
≥ 15 | 4 | 28 | |
Mitotic Index (/50 HPF) | 1 (0–11) | 8 (1–210) | < 0.001* |
≤ 5 | 18 | 88 |
0.0004* |
6–10 | 1 | 27 | |
> 10 | 1 | 85 | |
NIH criterion | |||
Intermediate | 3 | 32 | 1 |
High | 17 | 168 | |
Predictive parameters of malignancy | 0 (0–2) | 2 (1–6) | < 0.001* |
0 | 11 | 42 | < 0.001* |
1–2 | 9 | 77 | |
> 2 | 0 | 81 | |
Mutational status | |||
c-kit | 9 | 145 | < 0.001* |
PDGFRα | 2 | 4 | |
Neither | 9 | 18 | |
Adjuvant imatinib | |||
Yes | 3 | 49 | 0.498 |
No | 17 | 151 |