外科ジャーナル

Gastrointestinal Stromal Tumors: Diagnostic and Therapeutic Challenges

Abstract

Ibrahim Abdelkader Salama, Waleed Hammam Mosa, Mohamed Elsherbini, Mohamed Abbasy, Mohamed Houseni and Mohamed Badr

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the digestive system. They originate from the interstitial cells of Cajal and are characterized by the over expression of KIT protein (Tyrosine Kinase), and they pose a diagnostic and therapeutic dilemma.

Objective: A challenge in diagnosis and treatment of GIST

Patients & Methods: This is a retrospective study of GIST cases that diagnosed and treated in our center during the past 5 years. These studies include clinical characteristics, imaging techniques, neoadjuvant therapy, surgical techniques, immunohistochemistry, and prognosis of such cases. Results: Sixteen patients were diagnosed as having GIST (12 males/4 females) with a mean age 62 years (31-83 years). Diagnosis was made preoperatively in 11 patients (69%) and intraoperatively with histopatholgical confirmation in five patients (31%). The site of the tumor was detected in the stomach in 6 cases (37.5%), one in duodenum (6.25%), five in small intestine (31.25%), one in mesentery (6.25%), two in colon (12.5%) and one rectal GIST (6.25%). The main presentation of the disease was anemia, GIT bleeding and abdominal mass. Fourteen patients considered resectable and they were operated upon (87.5%) and in two patients (12.5%) neadjuvant therapy was started with favorable response in one case and poor response in other one with advanced GIST. All patients received Imatinib as adjuvant therapy. Mean follow up period was 33 months (4-54 months).

Conclusion: GIST is a complex and challenging disease that requires a multidisciplinary approach in specililized center for better prognosis of such disease.