Abstract
Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. Results: The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). Conclusions: Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.
Highlights
Gastrointestinal stromal tumors (GISTs) are well-understood mesenchymal tumors that originate from the interstitial cells of Cajal known as intestinal pacemakers [1]
There have been some prognostication systems introduced to predict malignant potential such as metastasis or recurrence, with several studies reporting that tumor size, mitotic index, primary tumor site, and tumor rupture are associated with prognosis in patients with GISTs [6,7,8,9]
Yasui et al reported the heterogeneity of gastric GIST lesions using the MIB-1 index, and the discrepancy in the result might be due to the difference of the patient characteristics included: our study included only resectable gastric GISTs, but patients included in the study by Yasui et al showed much larger mean diameter of GIST (6.9 ± 2.73 vs. 3.56 ± 2.10) [12]
Summary
Gastrointestinal stromal tumors (GISTs) are well-understood mesenchymal tumors that originate from the interstitial cells of Cajal known as intestinal pacemakers [1]. Risk stratification in patients with GISTs is important to determine treatment, follow-up strategies, and prognosis. There have been some prognostication systems introduced to predict malignant potential such as metastasis or recurrence, with several studies reporting that tumor size, mitotic index, primary tumor site, and tumor rupture are associated with prognosis in patients with GISTs [6,7,8,9]. According to the National Institutes of Health consensus criteria published in 2002, the most important prognostic factors of GISTs are mitotic index and tumor size [9]. Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University
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