Diagnosis Of Extragastrointestinal Stromal Tumor Research Articles

Primary extragastrointestinal stromal tumor of the prostate: review of the literature and case report.

A 58-year-old man was presented with lower urinary tract symptoms for 6 months. A digital rectal examination revealed a markedly enlarged prostate with a smooth, bulging surface. Prostate-specific antigen density was 0.5ng/ml. MRI of the prostate showed an enlarged prostatic mass with hemorrhagic necrosis. Transrectal ultrasound-guided prostate biopsy was performed and pathological reports suggested a gastrointestinal stromal tumor. The patient refused radical prostatectomy and received only imatinib treatment. The diagnosis of EGIST of the prostate is extremely rare and depends on the histopathologic features with immunohistochemical results. The treatment is essentially based on radical prostatectomy, but there are other therapeutic modalities associating surgery with adjuvant or neoadjuvant chemotherapy. For patients refusing surgery, treatment with imatinib alone appears to be a therapeutic solution. Despite the rarity, EGIST of the prostate should be included in the differential diagnosis of patients presenting with lower urinary tract symptoms. There is no consensus regarding the treatment of EGIST, and the patients are treated as per the risk stratification.

Gastrointestinal stromal tumors (GIST) presenting in the liver: Diagnostic, prognostic and therapeutic issues

Extra-gastrointestinal stromal tumors (E-GIST) presenting in the liver are exceedingly rare and raise difficult diagnostic and therapeutic challenges. We report on two cases of liver E-GIST with different clinical presentations. We describe their clinical and imaging features, their histopathological and molecular characteristics, their treatment and their course. The first case was that of a 56-year-old male presenting with a 10-cm liver mass; the initial diagnosis, made in 1986 from a biopsy sample, was leiomyosarcoma; liver transplantation was performed in 1987; no extra-hepatic tumor was found; the course was uneventful until 1999, when tumor recurrence was diagnosed along the initial biopsy route; after reevaluation of available material, the definitive pathological diagnosis was GIST; imatinib treatment resulted in major response; the patient died of end-stage kidney disease 22 years after the initial diagnosis and 9 years after tumor recurrence. The second case is that of a 59-year-old female presenting with a 23-cm abdominal mass connected to the liver; on biopsy, the tumor was diagnosed as epithelioid GIST with exon 11 KIT mutation; imatinib treatment resulted in stable disease. The diagnosis of E-GIST must be for any sarcoma presenting in the liver and confirmed by immunohistochemical and molecular techniques. Treatment might require aggressive strategies, which can be successful despite apparently adverse histoprognostic factors.

Extragastrointestinal stromal tumors: Computed tomography and magnetic resonance imaging findings

Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors that originate outside the gastrointestinal tract. The aim of the present study was to investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of EGISTs and analyze the correlations between radiological findings and pathological features. CT and MRI images of 24 patients with EGISTs were reviewed retrospectively. Patient demographics and tumor characteristics, including localization, size, contours, borders, cystic-necrotic components, calcification, hemorrhage, tumor vessels, attenuation and intensity, degree and pattern of enhancement, ascites, tumor invasion, lymphadenopathy and distant metastasis were recorded. Statistical analyses to compare the radiological characteristics of low- and high-grade EGISTs were performed with χ2 or Fisher’s exact tests. The mean patient age at the time of presentation was 53 years. A total of 24 EGISTs were detected, originating in the omentum (n=4), mesentery (n=19) and retroperitoneum (n=1), respectively. The EGISTs displayed a predominantly spindle cell subtype (87.5%; 21/24). The majority of the EGISTs appeared as large (>10 cm; 70.8%; 17/24), round or oval (66.7%; 16/24), cystic-solid (87.5%; 21/24) and ill-defined (66.7%; 16/24) soft-tissue masses. The EGISTs were hypodense (69.6%; 16/23) or isodense (30.4%; 7/23) on CT images, hypointense (50%; 3/6), isointense (33.3%; 2/6) or hyperintense (16.7%; 1/6) on T1-weighted imaging (T1WI), and hyperintense on T2WI (100%; 6/6) and diffusion-WI (DWI; 100%; 6/6). A total of 54.2% (13/24) of the EGISTs displayed tumor vessels. Overall, 95.8% (23/24) of the masses showed marked enhancement and 87.5% (21/24) demonstrated heterogeneous enhancement. Calcification, hemorrhage, ascites and lymphadenopathy were rare characteristics in the EGISTs. Distant metastases were present in 10 patients (41.7%). The size, borders, tumor vessels and distant metastasis correlated with high-grade EGISTs [>5 mitoses/50 high-power fields (HPFs)] (P<0.05). The results of the present study indicated that clinical and radiological features, including advanced age, a large tumor size, cystic-necrotic components, rare lymphadenopathy, a heterogeneous enhancement pattern and hepatic metastasis may aid in the diagnosis of EGISTs. Radiological characteristics, such as a large size (>10 cm), ill-defined borders, tumor vessels and distant metastasis, can provide useful information in identifying the malignant behavior of EGISTs.

Misdiagnosis of an Extragastrointestinal Stromal Tumor in the Rectovaginal Septum

Gastrointestinal stromal tumors are very rare, representing 0.1% to 1% of gastrointestinal malignancies. Gastrointestinal stromal tumors outside the digestive tract comprise a very small fraction of all gastrointestinal stromal tumors, and their most common locations are the omentum, the mesentery, and, in few cases, the rectovaginal septum. Despite their low incidence, extragastrointestinal stromal tumors are potentially malignant tumors and they present a high rate of recurrences. This, added to the fact that they are often asymptomatic until advanced stages, determines an unfavorable prognosis. We report a case of gastrointestinal stromal tumor located in the rectovaginal septum, which recurred after local excision; hence, a reintervention was needed. A correct differential diagnosis between extragastrointestinal stromal tumors and other similar pathologies such as leiomyomas or schwannomas is imperative based on their histology and immunohistochemistry. The correct diagnosis of extragastrointestinal stromal tumors allows to start adequate treatment and follow-up, preventing recurrence that determines their poor prognosis.

Diagnosis of extra-gastrointestinal stromal tumors by MSCT and MRI

Diagnosis of extra-gastrointestinal stromal tumors by MSCT and MRI

HISTOPATHOLOGICAL CHARACTERISTICS AND IMMUNOCHEMICAL EXPRESSING IN EXTRAGASTROINTESTINAL STROMAL TUMORS

Background: Extragastrointestinal stromal tumors (EGISTs) are gastrointestinal stromal tumors(GISTs) that located in abdomen but outside the gastrointestinal tract. EGISTs is not common as GISTs with rate of 1-5%. Previously, EGISTs often diagnosed as gastrointestinal smooth muscle tumors, fibrous tumor or schwannomas. After the presence of the c-kit selective therapy administration(specified inhabition of CD117), the same as GIST, the EGIST are well responsed to this therapy, even when the tumors are at late stages such as invasion or metastasis. . Up to now immunohistochemistry has been indispensable for the diagnosis of EGIST in addition to the standard histopathology. Objectives: To classify the mesenchymal tumors in the abdomen outside the gastrointestinal tract. To study the Histopathological characteristics and Immunohistochemistrical expressing in EGIST. Materials and methods: discriptive research of 14 mesenchymal tumors in the abdomen outside the gastrointestianl tract. Using the inside and outside control for the immunohistochemistrical assessment. Results: 8/14 (57,1%) of these were GISTs, following the leiomyomas and leiomyosarcomas (21,3%). The others are less common including Schwannomas, fibromatosis and lipoma. The EGIST size: 10cm to 35cm, the average 19cm. The fusiform EGISTs accounting for 75%, the other types are less common, encompassing epithelioid and mixed tumors. Risk of Aggressive Behavior in EGIST: the high risk encompassing 100%. The positive proportion of the immunochemistrical markers: CD117 (100%), CD34 (62,5%), SMA (25%), S100 (12,5%). Desmin and CK negative in all cases.

Laparoscopic resection of extra-gastrointestinal stromal tumor of the transverse mesocolon

The patient was a 58-year-old man. A recent complete work-up was done to find the cause of epigastric pain and revealed a nodule about 4 cm in diameter in the upper right abdomen on CT scans. Laparoscopic resection was performed to allow for a definitive diagnosis to be made and to treat the lesion. The tumor was located in the transverse mesocolon, and there was no communication between the lesion and the ascending or transverse colon. Spindle-shaped tumor cells were arranged in palisades. The number of mitotic figures was only 1/50 HPF. The tumor was weakly positive for KIT and negative for CD34. From these findings, a diagnosis of extra-gastrointestinal stromal tumor originating in the transverse mesocolon was made.