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Indian Journal of Gastroenterology

, Volume 29, Issue 6, pp 231–236 | Cite as

Gastrointestinal stromal tumors: a clinicopathological and immunohistochemical study of 121 cases

  • Mukul Vij
  • Vinita Agrawal
  • Ashok Kumar
  • Rakesh Pandey
Article

Abstract

Background

Primary mesenchymal tumors of the gastrointestinal tract are a heterogeneous group of tumors with a wide clinical spectrum, of which gastrointestinal stromal tumors (GIST) typically occur in middle-aged to older individuals. This study evaluated the clinicopathological and morphological features of GIST of the intestinal tract.

Methods

The study included 108 gastrointestinal and 13 extra-gastrointestinal stromal tumors involving the mesentry and retroperitoneum between January 1989 and July 2007. Immunohistochemical expression of CD117, CD34, SMA, Desmin, S100, and Ki-67 were studied.

Results

GIST comprised 108 of 120 (90%) of the mesenchymal tumors. The tumor was located in the stomach in the majority (55%) of patients followed by small intestine (30%), retroperitoneum (7%) and the colorectum (4%). There was a significant correlation between tumor size and mitotic index, with larger tumors having higher mitotic index (p < 0.001). Mitotic index per 5 mm2 correlated with high cellularity (p < 0.001), presence of necrosis (p < 0.001) and presence of mucosal invasion (p = 0.01). Expression of CD117 was seen in 94%, CD34 in 59%, SMA in 41%, S-100 in 33%, and desmin in 4% of tumors.

Conclusion

We found GIST to be the most common mesenchymal tumor of the gastrointestinal tract.

Keywords

CD117 Gastrointestinal stromal tumors Gastrointestinal tract Immunophenotyping Stomach Tumor 

References

  1. 1.
    Mazur MT, Clark HB. Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol. 1983;7:507–19.CrossRefPubMedGoogle Scholar
  2. 2.
    Miettinen M, Virolainen M, Sarlomo-Rikala M. Gastrointestinal stromal tumors—value of CD34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol. 1995;19:207–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Hirota S, Isozaki K, Moriyama Y, et al. Gain of function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Sarlomo-Rikala M, Kovatich AJ, Barusevicius A, et al. CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Mod Pathol. 1998;11:728–34.PubMedGoogle Scholar
  5. 5.
    Lamba M, Mukherjee G, Saini K, et al. Clinico-pathologic pattern of gastrointestinal stromal tumours (GIST) in southern India: A single-institution experience (abstract). J Clin Oncol. 2007;25(18S):20531.Google Scholar
  6. 6.
    Nada R, Vaiphei K, Singh R, et al. Gastrointestinal stromal tumours the assessment of malignant potential. Indian J Pathol Microbiol. 2001;44:393–7.PubMedGoogle Scholar
  7. 7.
    Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23:70–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Agaimy A, Wunsch PH. Gastrointestinal stromal tumours: a regular origin in the muscularis propria, but an extremely diverse gross presentation. A review of 200 cases to critically re-evaluate the concept of so-called extra-gastrointestinal stromal tumours. Langenbecks Arch Surg. 2006;39:322–9.CrossRefGoogle Scholar
  9. 9.
    Reith JD, Goldblum GR, Lyles RH, et al. Extragastrointestinal (soft tissue) stromal tumors: an analysis of 48 cases with emphasis on histologic predictors of outcome. Mod Pathol. 2000;13:577–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Miettinen M, Monihan JM, Sarlomo-Rikala M, et al. Primary in the omentum and mesentery: Clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol. 1999;23:1109–18.CrossRefPubMedGoogle Scholar
  11. 11.
    Steigen SE, Eide TJ. Trends in incidence and survival of mesenchymal neoplasm of the digestive tract within a defined population of Northern Norway. APMIS. 2006;114:192–200.CrossRefPubMedGoogle Scholar
  12. 12.
    Ahmed I, Welch NT, Parsons SL. Gastrointestinal stromal tumors (GIST)—17 years experience from Mid Trent Region (United Kingdom). Eur J Surg Oncol. 2008;34:445–9.PubMedGoogle Scholar
  13. 13.
    Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: An analysis of 1, 458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100:162–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Dematteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Bümming P, Ahlman H, Andersson J, et al. Population-based study of the diagnosis and treatment of gastrointestinal stromal tumours. Br J Surg. 2006;93:836–43.CrossRefPubMedGoogle Scholar
  16. 16.
    Kim KM, Kang DW, Moon WS, et al. Gastrointestinal stromal tumors in Koreans: its incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci. 2005;20:977–84.CrossRefPubMedGoogle Scholar
  17. 17.
    Nilsson B, Bumming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer. 2005;103:821–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Rutkowski P, Nowecki ZI, Michej W, et al. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor. Ann Surg Oncol. 2007;14:2018–27.CrossRefPubMedGoogle Scholar
  19. 19.
    Brainard JA, Goldblum JR. Stromal tumors of the jejunum and ileum: a clinicopathologic study of 39 cases. Am J Surg Pathol. 1997;21:407–16.CrossRefPubMedGoogle Scholar
  20. 20.
    Tworek JA, Appelman HD, Singleton TP, et al. Stromal tumors of the jejunum and ileum. Mod Pathol. 1997;10:200–9.PubMedGoogle Scholar
  21. 21.
    Miettinen M, Sarlomo-Rikala M, Sobin LH, et al. Gastrointestinal stromal tumors and leiomyosarcomas in the colon: a clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases. Am J Surg Pathol. 2000;24:1339–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Miettinen M, Shekitka KM, Sobin LH. Schwannomas in the colon and rectum: a clinicopathologic and immunohistochemical study of 20 cases. Am J Surg Pathol. 2001;25:846–55.CrossRefPubMedGoogle Scholar
  23. 23.
    Hasegawa T, Matsuno Y, Shimoda T, et al. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol. 2002;33:669–76.CrossRefPubMedGoogle Scholar
  24. 24.
    Orosz Z, Tornóczky T, Sápi Z. Gastrointestinal stromal tumors: a clinicopathologic and immunohistochemicalstudy of 136 cases. Pathol Oncol Res. 2005;11:11–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Alvarado-Cabrero I, Vázquez G, Sierra Santiesteban FI, et al. Clinicopathologic study of 275 cases of gastrointestinal stromal tumors: The experience at 3 large medical centers in Mexico. Ann Diagn Pathol. 2007;11:39–45.CrossRefPubMedGoogle Scholar
  26. 26.
    Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005;29:52–68.CrossRefPubMedGoogle Scholar
  27. 27.
    Trupiano JK, Stewart RE, Misick C, et al. Gastric stromal tumors: a clinicopathologic study of 77 cases with correlation of features with nonaggressive and aggressive clinical behaviors. Am J Surg Pathol. 2002;26:705–14.CrossRefPubMedGoogle Scholar
  28. 28.
    Miettinen M, Makhlouf H, Sobin LH, et al. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J Surg Pathol. 2006;30:477–89.CrossRefPubMedGoogle Scholar
  29. 29.
    Iesalnieks I, Rümmele P, Dietmaier W, et al. Factors associated with disease progression in patients with gastrointestinal stromal tumors in the pre-imatinib era. Am J Clin Pathol. 2005;124:740–48.CrossRefPubMedGoogle Scholar
  30. 30.
    Medeiros F, Corless CL, Duensing A, et al. KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications. Am J Surg Pathol. 2004;28:889–94.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2011

Authors and Affiliations

  • Mukul Vij
    • 1
  • Vinita Agrawal
    • 1
  • Ashok Kumar
    • 2
  • Rakesh Pandey
    • 1
  1. 1.Department of PathologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of Surgical GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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