Introduction
This study was designed to review the clinical characteristics of surgically treated gastrointestinal stromal tumors of the colon and rectum, evaluate their immunohistochemical and pathologic features based on the current National Institutes of Health criteria, and correlate clinicopathologic findings with the subsequent clinical course.
Methods
Patient and disease characteristics at presentation, pathologic features, surgical management, and clinical outcomes of 18 patients with gastrointestinal stromal tumors (4 colon and 14 rectum) diagnosed and primarily treated at our institution between 1979 and 2004 were evaluated.
Results
Tumors were classified on basis of size and mitotic rate according to current National Institutes of Health recommendations: 67 percent (n = 12) were high-risk, 5 percent (n = 1) were intermediate-risk, 17 percent (n = 3) were low-risk, and 11 percent (n = 2) were very low-risk gastrointestinal stromal tumors. Fifteen of 18 tumors were KIT-positive. The three KIT-negative tumors were platelet-derived growth factor receptor alpha positive. All patients with colonic gastrointestinal stromal tumors (n = 4) underwent segmental resection, whereas patients with rectal gastrointestinal stromal tumors had local excision (n = 5) or radical resection (n = 9). Sixty-six percent (8/12) of patients with high-risk colorectal gastrointestinal stromal tumors developed metastases. None of the patients (n = 6) with intermediate-risk, low-risk, or very low-risk gastrointestinal stromal tumors died of their disease after a median follow-up of 65 (range, 15–266) months.
Conclusions
The majority of gastrointestinal stromal tumors of the colon and rectum are high-risk. Patients with high-risk colorectal gastrointestinal stromal tumors have a significant likelihood of developing metastases that is associated with poor prognosis. These patients need to be closely followed for an extended period and should be considered for adjuvant therapy with tyrosine kinase inhibitors.
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References
TS Emory LH Sobin L Lukes DH Lee TJ O'Leary (1999) ArticleTitlePrognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site Am J Surg Pathol 23 82–87 Occurrence Handle10.1097/00000478-199901000-00009 Occurrence Handle1:STN:280:DyaK1M7gtlOrsA%3D%3D Occurrence Handle9888707
RP Dematteo MC Heinrich WM El-Rifai G Demetri (2002) ArticleTitleClinical management of gastrointestinal stromal tumors: before and after STI-571 Hum Pathol 33 466–477 Occurrence Handle10.1053/hupa.2002.124122 Occurrence Handle1:CAS:528:DC%2BD38XlslCls7o%3D Occurrence Handle12094371
S Hirota K Isozaki Y Moriyama et al. (1998) ArticleTitleGain-of-function mutations of c-kit in human gastrointestinal stromal tumors Science 279 577–580 Occurrence Handle10.1126/science.279.5350.577 Occurrence Handle1:CAS:528:DyaK1cXotVyhsw%3D%3D Occurrence Handle9438854
MC Heinrich CD Blanke BJ Druker CL Corless (2002) ArticleTitleInhibition of KIT tyrosine kinase activity: a novel molecular approach to the treatment of KIT-positive malignancies J Clin Oncol 20 1692–1703 Occurrence Handle10.1200/JCO.20.6.1692 Occurrence Handle1:CAS:528:DC%2BD38XivFeit7o%3D Occurrence Handle11896121
GD Demetri M Mehren Particlevon CD Blanke et al. (2002) ArticleTitleEfficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors N Engl J Med 347 472–480 Occurrence Handle10.1056/NEJMoa020461 Occurrence Handle1:CAS:528:DC%2BD38XmtV2nt7s%3D Occurrence Handle12181401
AT Oosterom Particlevan IR Judson J Verweij et al. (2002) ArticleTitleUpdate of phase I study of imatinib (STI571) in advanced soft tissue sarcomas and gastrointestinal stromal tumors: a report of the EORTC Soft Tissue and Bone Sarcoma Group Eur J Cancer 38 IssueID(Suppl 5) S83–S87 Occurrence Handle10.1016/S0959-8049(02)80608-6 Occurrence Handle12528778
J Verweij PG Casali J Zalcberg et al. (2004) ArticleTitleProgression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial Lancet 364 1127–1134 Occurrence Handle10.1016/S0140-6736(04)17098-0 Occurrence Handle1:CAS:528:DC%2BD2cXnvVOiu7o%3D Occurrence Handle15451219
J Verweij A Oosterom Particlevan JY Blay et al. (2003) ArticleTitleImatinib mesylate (STI-571 Glivec, Gleevec) is an active agent for gastrointestinal stromal tumours, but does not yield responses in other soft-tissue sarcomas that are unselected for a molecular target. Results from an EORTC Soft Tissue and Bone Sarcoma Group phase II study EurJ Cancer 39 2006–2011 Occurrence Handle10.1016/S0959-8049(02)00836-5 Occurrence Handle1:CAS:528:DC%2BD3sXmvVKgtrc%3D
BL Eisenberg I Judson (2004) ArticleTitleSurgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy Ann Surg Oncol 11 465–475 Occurrence Handle10.1245/ASO.2004.09.011 Occurrence Handle15123459
M Miettinen M Furlong M Sarlomo-Rikala et al. (2001) ArticleTitleGastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases Am J Surg Pathol 25 1121–1133 Occurrence Handle10.1097/00000478-200109000-00002 Occurrence Handle1:STN:280:DC%2BD3MnjsFajsg%3D%3D Occurrence Handle11688571
JA Tworek JR Goldblum SW Weiss JK Greenson HD Appelman (1999) ArticleTitleStromal tumors of the abdominal colon: a clinicopathologic study of 20 cases Am J Surg Pathol 23 937–945 Occurrence Handle10.1097/00000478-199908000-00012 Occurrence Handle1:STN:280:DyaK1MzmtF2itQ%3D%3D Occurrence Handle10435564
M Miettinen LH Sobin J Lasota (2005) ArticleTitleGastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up Am J Surg Pathol 29 52–68 Occurrence Handle10.1097/01.pas.0000146010.92933.de Occurrence Handle15613856
M Miettinen J Kopczynski HR Makhlouf et al. (2003) ArticleTitleGastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases Am J Surg Pathol 27 625–641 Occurrence Handle10.1097/00000478-200305000-00006 Occurrence Handle12717247
RP DeMatteo JJ Lewis D Leung et al. (2000) ArticleTitleTwo hundred gastrointestinal stromal tumors: recurrence patterns andprognostic factors for survival Ann Surg 231 51–58 Occurrence Handle10.1097/00000658-200001000-00008 Occurrence Handle1:STN:280:DC%2BD3c7gtVSmtQ%3D%3D Occurrence Handle10636102
PC Wu A Langerman CW Ryan et al. (2003) ArticleTitleSurgical treatment of gastrointestinal stromal tumors in the imatinib (STI-571) era Surgery 134 656–665 Occurrence Handle10.1016/S0039-6060(03)00314-3 Occurrence Handle14605627
T Aparicio V Boige JC Sabourin et al. (2004) ArticleTitlePrognostic factorsafter surgery of primary resectable gastrointestinalstromal tumours Eur J Surg Oncol 30 1098–1103 Occurrence Handle10.1016/j.ejso.2004.06.016 Occurrence Handle1:STN:280:DC%2BD2crltVOlsQ%3D%3D Occurrence Handle15522557
I Besana-Ciani L Boni G Dionigi A Benevento R Dionigi (2003) ArticleTitleOutcome and long term results of surgicalresection for gastrointestinal stromal tumors (GIST) Scandinavian Journal of Surgery: SJS 92 195–199 Occurrence Handle1:STN:280:DC%2BD3srgsFWgtQ%3D%3D Occurrence Handle14582540
CR Antonescu A Viale L Sarran et al. (2004) ArticleTitleGene expression in gastrointestinal stromal tumors is distinguished by KIT genotype and anatomic site Clin Cancer Res 10 3282–3290 Occurrence Handle10.1158/1078-0432.CCR-03-0715 Occurrence Handle1:CAS:528:DC%2BD2cXkt1Ghs70%3D Occurrence Handle15161681
B Wasag M Debiec-Rychter P Pauwels et al. (2004) ArticleTitleDifferential expression of KIT/PDGFRA mutant isoforms in epithelioid and mixed variants of gastrointestinal stromal tumors depends predominantly on the tumor site Mod Pathol 17 889–894 Occurrence Handle10.1038/modpathol.3800136 Occurrence Handle1:CAS:528:DC%2BD2cXmvVOltro%3D Occurrence Handle15154005
M Miettinen LH Sobin M Sarlomo-Rikala (2000) ArticleTitleImmunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT) Mod Pathol 13 1134–1142 Occurrence Handle10.1038/modpathol.3880210 Occurrence Handle1:STN:280:DC%2BD3crgtFektQ%3D%3D Occurrence Handle11048809
JA Tworek JR Goldblum SW Weiss JK Greenson HD Appelman (1999) ArticleTitleStromal tumors of the anorectum: a clinicopathologic study of 22 cases Am J Surg Pathol 23 946–954 Occurrence Handle10.1097/00000478-199908000-00013 Occurrence Handle1:STN:280:DyaK1MzmtF2iug%3D%3D Occurrence Handle10435565
CR Changchien MC Wu WS Tasi et al. (2004) ArticleTitleEvaluation of prognosis for malignant rectal gastrointestinal stromal tumor by clinical parameters and immunohistochemical staining Dis Colon Rectum 47 1922–1929 Occurrence Handle10.1007/s10350-004-0687-8 Occurrence Handle15622586
CD Fletcher JJ Berman C Corless et al. (2002) ArticleTitleDiagnosis of gastrointestinal stromal tumors: A consensus approach Hum Pathol 33 459–465 Occurrence Handle10.1053/hupa.2002.123545 Occurrence Handle12094370
W Ruka P Rutkowski Z Nowecki A Nasierowska-Guttmejer M Debiec-Rychter (2004) ArticleTitleOther malignant neoplasms in patients with gastrointestinal stromal tumors (GIST) Med Sci Monit 10 LE13–LE14 Occurrence Handle15278004
M Chacon E Roca M Barugel et al. (2004) ArticleTitleReport of solid cancer in patients (pts) with gastrointestinal stromal tumours (GIST) Journal of Clinical Oncology ASCO Annual Meeting Proceedings (Post-Meeting Edition) 22 9065
M Miettinen M Sarlomo-Rikala LH Sobin (2001) ArticleTitleMesenchymal tumors of muscularis mucosae of colon and rectum are benign leiomyomas that should be separated from gastrointestinal stromal tumors—a clinicopathologic and immunohistochemical study of eighty-eight cases Mod Pathol 14 950–956 Occurrence Handle10.1038/modpathol.3880417 Occurrence Handle1:STN:280:DC%2BD3MrltFynsQ%3D%3D Occurrence Handle11598163
M Miettinen KM Shekitka LH Sobin (2001) ArticleTitleSchwannomas in the colon and rectum: a clinicopathologic and immunohistochemical study of 20 cases Am J Surg Pathol 25 846–855 Occurrence Handle1:STN:280:DC%2BD3MzlvFeqtA%3D%3D Occurrence Handle11420455
F Medeiros CL Corless A Duensing et al. (2004) ArticleTitleKIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications Am J Surg Pathol 28 889–894 Occurrence Handle15223958
MC Heinrich CL Corless A Duensing et al. (2003) ArticleTitlePDGFRA activating mutations in gastrointestinal stromal tumors Science 299 708–710 Occurrence Handle10.1126/science.1079666 Occurrence Handle1:CAS:528:DC%2BD3sXntFWitQ%3D%3D Occurrence Handle12522257
S Hirota A Ohashi T Nishida et al. (2003) ArticleTitleGain-of-function mutations of platelet-derived growth factor receptor alpha gene in gastrointestinal stromal tumors Gastroenterology 125 660–667 Occurrence Handle10.1016/S0016-5085(03)01046-1 Occurrence Handle1:CAS:528:DC%2BD3sXnvVSiur8%3D Occurrence Handle12949711
CL Corless JA Fletcher MC Heinrich (2004) ArticleTitleBiology of gastrointestinal stromal tumors J Clin Oncol 22 3813–3825 Occurrence Handle10.1200/JCO.2004.05.140 Occurrence Handle1:CAS:528:DC%2BD2cXhtVCitb%2FL Occurrence Handle15365079
M Miettinen M Sarlomo-Rikala LH Sobin J Lasota (2000) ArticleTitleGastrointestinal stromal tumors and leiomyosarcomas in the colon: A clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases Am J Surg Pathol 24 1339–1352 Occurrence Handle10.1097/00000478-200002000-00007 Occurrence Handle1:STN:280:DC%2BD3cvmvVagsA%3D%3D Occurrence Handle11023095
I Hassan SZ Park JH Donohue et al. (2004) ArticleTitleOperative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience Ann Surg 239 244–250 Occurrence Handle10.1097/01.sla.0000108670.31446.54 Occurrence Handle14745333
Dematteo RP, Antonescu CR, Chadaram Y, et al. Adjuvant imatinib mesylate in patients with primary high risk gastrointestinal stromal tumor (GIST) following complete resection: safety results from the U.S Intergroup Phase II trial ACOSOG Z9000 [abstract]. Proceedings of the American Society of Clinical Oncology 2005;22:9009.
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Hassan, I., You, Y.N., Dozois, E.J. et al. Clinical, Pathologic, and Immunohistochemical Characteristics of Gastrointestinal Stromal Tumors of the Colon and Rectum: Implications for Surgical Management and Adjuvant Therapies. Dis Colon Rectum 49, 609–615 (2006). https://doi.org/10.1007/s10350-006-0503-8
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DOI: https://doi.org/10.1007/s10350-006-0503-8