Gastric Stromal Tumors Research Articles

Pancreatic Undifferentiated Pleomorphic Sarcoma Mimicking a Gastric Gastrointestinal Stromal Tumor

Pancreatic Undifferentiated Pleomorphic Sarcoma Mimicking a Gastric Gastrointestinal Stromal Tumor

Feasibility of laparoscopic surgery for large gastric gastrointestinal stromal tumors: systematic review and meta-analysis

Feasibility of laparoscopic surgery for large gastric gastrointestinal stromal tumors: systematic review and meta-analysis

Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature

Application of NOTES combined with ESD for the treatment of an exogenous gastric stromal tumor: A case report and review of the literature

Think Hemangioma Think Well: Giant Pedunculated Hepatic Cavernous Hemangioma. A Case Report

Hepatic haemangiomas are the most common benign hepatic tumour; they are usually solitary, less than 5 cm in size, and clinically silent. Giant cavernous haemangiomas are a minor subset of hepatic haemangiomas, often symptomatic due to a mass lesion, complications or compression of adjacent structures. Few of these are pedunculated—often difficult to diagnose because of their exophytic development and greater tendency towards complications through the twisting of their peduncle. We report the case of a 55-year-old woman with a giant pedunculated hepatic cavernous haemangioma causing abdominal pain, with epigastralgia mimicking a gastric stromal tumour. We discuss the diagnostic workup, focusing on the useful of computed tomography and magnetic resonance imaging findings and giving a brief report of the therapeutic management and literature review.

Application of Computed Tomography Images Based on Peripheral Nerve Analysis in the Treatment of Gastric Scrotal Tumors

Gastric stromal tumor is a potentially malignant mesenchymal tumor that is difficult to diagnose before surgery. Computed tomography is the most commonly used tool for diagnosing gastrointestinal stromal tumor. This study combined peripheral nerve analysis and computed tomography for diagnosis and prognosis of gastrointestinal stromal tumor. This study shows that computed tomography can accurately show the location, shape, and size of gastric scrotal tumors and has important clinical value in identifying benign and malignant tumors as well as early clinical judgment and treatment and prognosis.

A rare case of eye complications of gastric stromal tumor treatment using imatinib mesylate

Purpose: to describe a clinical case of ocular complications of gastric stromal tumor treatment with imatinib mesylate. Material and methods . A patient aged 78 was examined by general ophthalmologic and instrumental methods, including ultrasound and spectral optical coherence tomography (SOCT). Results. Ophthalmoscopy helped diagnose a blunted foveal reflex of the right eye. In the left eye, fuzzy boundaries of the optic disc edema and the macular reflex, the presence of gray-yellow foci of an irregular shape with even distinct boundaries in the paramacular zone were revealed. In the lower part of the left eye fundus, a weakly pigmented gray-yellow focus with uneven indistinct boundaries and an uneven surface was to be seen. SOCT showed in the right eye a retinal edema in the macula and paramacular zones and an epiretinal membrane. In the left eye, SOCT showed vitreoretinal tractions and retinal edema on the edges of the optic nerve; in the paramacular zone and in the inner parts of the fundus, vitreoretinal tractions, epiretinal fibrosis, retinal edema was observed whilst in the lower parts of the fundus complete destruction of all retinal layers due to the hyperreflective focus with a small-shaped inner contour, an even choroidal profile with thinning of the choroid, vitreoretinal tractions, and epiretinal membrane in the left eye could be seen. Conclusions. The clinical case of eye complications of imatinib mesylate in the treatment of gastric stromal tumor necessitates an interdisciplinary integrated approach (involving an oncologist and an ocular oncologist) in the diagnosis and treatment of eye tumors. A complex of instrumental methods of diagnostics of eye fundus diseases involving additional refinement methods (SOCT) ensures differential diagnosis of retinopathy during the chemotherapy, secondary metastatic involvement, and vitreoretinal pathology of a different pathogenetic etiology. Early diagnosis facilitates providing adequate treatment aimed at preserving the patient’s vision, the eye, and life.

Early gastric cancer with three gastric gastrointestinal stromal tumors combined with synchronous colon cancer: a case report

BackgroundThere have been very few reports of patients with early gastric cancer (EGC) and colorectal cancer combined with gastric gastrointestinal stromal tumors (GISTs).Case presentationWe report the case of a patient with multiple tumors that were found at the same time in the abdomen. The patient was a 77-year-old man who was referred for a gastric GIST. Esophagogastroduodenoscopy showed the known lesion (a gastric GIST) on the lesser curvature of the upper body and a new lesion on the lesser curvature of the lower body of the stomach with suspicion of EGC. Computed tomography findings confirmed the presence of a GIST in the stomach and revealed two new lesions. One of these lesions was suspected to be a 4-cm submucosal tumor on the anterior wall of the upper body of the stomach. The other was a wall thickening of the descending colon that demonstrated the possibility of malignancy. Synchronous colon cancer was confirmed on colonoscopy. Laparoscopic near-total gastrectomy with D1+ lymph node dissection and left hemicolectomy were performed sequentially without significant events. The patient was discharged without any postoperative complications.ConclusionsWe reported a rare case of EGC with multiple gastric GISTs combined with synchronous colon cancer.

Differentiation of gastric glomus tumor from small gastric stromal tumor by computed tomography.

ObjectiveThis study was performed to investigate the value of computed tomography (CT) in the differentiation of gastric glomus tumors (GGTs) and small gastric stromal tumors (GSTs).MethodsFifty-nine patients with pathologically confirmed GGTs (n = 11) and GSTs (n = 48) from 2006 to 2019 were retrospectively evaluated. All patients’ preoperative CT imaging features were analyzed.ResultsThe following features were significantly different between GGTs and small GSTs: location in the antrum, endophytic growth, heterogeneous enhancement in the arterial phase, CT value in the arterial phase of ≥60.7 Hounsfield units (HU), CT value in the portal phase of ≥87.6 HU, degree of enhancement in the arterial phase of ≥29.9 HU, and degree of enhancement in the portal phase of ≥49.0 HU. A model including four randomly selected features among these seven criteria was built to differentiate GGTs from small GSTs with a sensitivity and specificity of 90.9% (10/11) and 100% (48/48), respectively.ConclusionWe identified seven features that are useful for differentiating GGTs from small GSTs. A combination of four of these seven criteria may increase the diagnostic accuracy.

The prognostic value of gender in gastric gastrointestinal stromal tumors: a propensity score matching analysis

BackgroundGastrointestinal stromal tumors (GISTs) of the stomach are the most common GISTs. The risk, incidence, and outcome of cancer are different between the sexes. Whether gender is related to the prognosis of gastric stromal tumors is unclear. Therefore, this study aims to explore the relationship between gender and gastric GIST prognosis.MethodsData from gastric GIST patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce confounding factors, and the clinicopathological features and prognosis of GIST patients were comprehensively evaluated.ResultsThere were 512 male patients and 538 female patients with gastric GIST. The gender of gastric GIST patients was associated with marital status, surgical treatment, tumor size, and mitotic index (P < 0.05). The Kaplan-Meier analysis and log-rank test revealed that male patients had a higher mortality rate than female patients (P = 0.0024). After matching all the potential confounding factors, the survival of the female gastric GIST patients was better than that of the male gastric GIST patients (P = 0.042). Cox regression analysis revealed that gender was an independent risk factor for overall survival. The risk of death was higher for males than for females (HR 1.677, 95% CI 1.150–2.444, P = 0.007).ConclusionGender could be a prognostic factor for gastric GIST survival, and male patients had a higher risk of death.

An extra-luminal gastric gastrointestinal stromal tumor (GIST) attached by a stalk identified by endoscopic ultrasonography

An extra-luminal gastric gastrointestinal stromal tumor (GIST) attached by a stalk identified by endoscopic ultrasonography

OTSC assisted EFTR for the treatment of GIST: 40 cases analysis

Background and aims To verify the safety and efficacy of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for the excision of stromal tumors. Material and methods Forty patients with gastric stromal tumors treated in the Department of Gastroenterology, Binzhou Medical University Hospital from December 2015 to March 2017 were included in this study. The surgical procedures included marking the lesion boundaries, cutting open the top surface of the lesion, installing an OTS, sucking the lesion into the transparent cap of the anatomical clip which was then released, application of an endoloop for EFTR, and confirming the complete resection and pathological examination of the lesion. Statistical analysis of the tumor site and size, operation time, success rates, complications, pathological examination results, and follow-up status was performed. Results The average operation duration was 38.40 ± 24.9 min. Three cases had an incomplete resection, but the lesion was later found to have fallen off together with the OTSC. Therefore, the treatment success rate was 100%. Postoperative pathological examination revealed leiomyomas in four cases and stromal tumors in the remaining 36 cases. Conclusions OTSC-assisted EFTR is safe and effective for resection of gastrointestinal stromal tumors, especially for those <20 mm in size.

Early Diagnosis and Treatment of a Small Gastric Stromal Tumor – A Case Report and Literature Review

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and the stomach is the most affected site. Clinical manifestation is erratic depending on the tumor’s location, size, histological type, and stage. Ultrasound is useful in detecting gastric intramural tumor whereas computed tomography is the imaging modality of choice in further evaluating tumor characteristics and expansion, treatment planning, and monitoring recurrence. Definite diagnosis of GISTs is based on the immunohistochemical study. Early diagnosis and complete surgical resection of the tumor yield good long-term outcomes. We present a case of a small gastric GIST which was early detected and treated and the patient has tumor-free during 8 years of follow-up.

Endoscopic management of the rare situation where a gastric stromal tumor specimen falls into the nasopharynx.

Endoscopic management of the rare situation where a gastric stromal tumor specimen falls into the nasopharynx.

A comprehensive characterization of anatomical and molecular risk factors in gastric gastrointestinal stromal tumor.

e23522 Background: Gastric gastrointestinal stromal tumors (GISTs) demonstrate a remarkable diversity in clinical behavior. Established risk criteria identify patients prone to recurrence with high sensitivity, but factors that could add specificity are needed. The aim of this study was to give a comprehensive picture of localized, gastric GIST and to investigate prognostic factors in a large population-based series. Methods: Patients with primary gastric GISTs completely resected between 2000 and 2018 were identified in the sarcoma database at Oslo University Hospital. Gastric subsite was divided into the upper, middle and lower thirds. Macroscopic growth pattern was coded as luminal, exophytic or transmural based on imaging and surgical reports. Mutation analysis was performed by Sanger sequencing of selected exons in KIT and PDGFRA and by targeted next-generation sequencing. Results: The cohort comprised 295 patients, representing 98% of patients in the region reported to the Cancer Registry of Norway. Of 292 tumors suitable for anatomical classification, 122 were located in the upper third of the stomach (41.8%), 120 in the middle (41.1%), and 50 in the lower third (17.1%). The number of luminal, exophytic and transmural tumors were 100 (34.1%), 94 (32.1%) and 99 (33.8%), and 2 tumors were not possible to classify. KIT mutations were detected in 183 of 256 tumors (71.5%), PDGFRA mutations in 62 (24.2%), whereas only 11 patients (4.3%) had KIT and PDGFRA wild-type tumors. Transmural tumors were larger, more often located in the upper third, had higher mitotic activity, and more frequently had KIT del557/558 mutations. KIT mutated tumors had a predilection for the upper two thirds and PDGFRA mutated tumors for the lower two thirds. Recurrences were rare among patients with luminal or exophytic tumors, with a 5-year RFS of 96% versus 71% with transmural tumors (HR 8.45; 95% CI 3.69-19.36; P&lt; 0.001). RFS was inferior with transmural tumor growth also among high-risk patients, 46% versus 83% at 5 years ( P= 0.001). Excluding patients with tumor rupture, there was only one recurrence among 24 high-risk patients with luminal or exophytic primaries, of whom 11 did not receive adjuvant therapy. Conclusions: This study provides a comprehensive, population-based description of the anatomical and molecular landscape of gastric GIST, with findings of potential clinical relevance. Transmural tumor growth was a predictor of poor outcome and could supplement established risk factors in selecting patients for adjuvant imatinib treatment.

Difference in Perfusion Parameters Between Gastric Cancer and Gastric Stromal Tumors: Evaluation With Oral Contrast Plus Contrast-Enhanced Ultrasonography.

Objective: To explore the difference of perfusion parameters between gastric cancer (GC) and gastric stromal tumors (GSTs) by using oral contrast plus contrast-enhanced ultrasonography (OC+CEUS).Methods: We retrospectively reviewed 149 patients with histologically confirmed gastric lesions (80 patients with GC and 69 patients with GST). OC+CEUS was performed in all patients in the GC group and the GST group before surgery. The cine loops of OC+CEUS of all cases were analyzed. The perfusion parameters including arrival time (AT), time to peak (TTP), basal intensity (BI), and peak intensity (PI) were obtained via a program designed for autotracking contrast quantification (ACQ). The between-group differences in these parameters were compared.Results: According to time-intensity curve (TIC) analysis, high-risk GST had higher PI than low-risk GST (P < 0.05). GC had faster AT and higher PI than normal gastric wall (P < 0.05); GST had higher PI than normal gastric wall (P < 0.05). Furthermore, the GC group had faster AT and higher PI than the GST group (P < 0.05). In contrast, the difference in BI and peak time (TTP) between the groups was not significant (P > 0.05).Conclusion: AT and PI differ significantly between the GC group and the GST group. As a new method, OC+CEUS has value for the differential diagnosis of GC and GST.

Clip- and snare-assisted endoscopic full-thickness resection (also named as m-EFTR or chen-EFTR) for the removal of an irregular gastric gastrointestinal stromal tumor that originate from the muscularis propria layer

Clip- and snare-assisted endoscopic full-thickness resection (also named as m-EFTR or chen-EFTR) for the removal of an irregular gastric gastrointestinal stromal tumor that originate from the muscularis propria layer

Surgical Treatment of Gastric GIST: Feasibility of Laparoscopic Resection and Postoperative Outcome.

The aim of this study is to evaluate clinical manifestations and the possibility of laparoscopic treatment of large gastric stromal tumors. A case-series. Place and Duration of the Study: Ist Surgical Unit, Saint Spiridon Hospital Iasi and the Ist Oncological Surgical Unit, Regional Institute of Oncology Iasi, Romania, from May 2012 to May 2017. Patients with gastrointestinal stromal tumors (GISTs) who underwent surgery were selected. The clinical manifestations, type of surgical treatment, postoperative assessment of the risk factors, and follow-up for at least two years were analysed. Tumors longer than 5 cm were classified as large tumors. Forty-eight patients with GIST were seen, of which 25 (52.08%) had gastric tumor. Nine laparoscopic resections and 16 open interventions were performed on tumors up to 10 cm in size. The histopathological examination revealed 10 patients (40%) as class risk 3a / 3b. Complications were more frequent in open surgery, with an overall rate of 43.75% (7 patients) vs. 33.33% (3 patients) in laparoscopic surgery. Laparoscopic surgical procedures performed in experienced centres can also be applied to gastric tumors over 5 cm in well-selected cases without repercussions on survival. Key Words: Laparoscopy, Gastrointestinal stromal tumor, Gastric, Resection.

Primary isolated asymptomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review

BackgroundPrimary isolated gastric TB of the cardia presenting as a submucosal tumor is extremely rare.Case presentationA 60-year-old female was admitted to our department; endoscopy revealed a smooth protruding lesion in the gastric cardia. The patient was diagnosed with a gastric cardia stromal tumor and the lesion was seen in muscularis propria by endoscopic ultrasonography (EUS). Endoscopic submucosal dissection (ESD) revealed that the lesion was filled with a milky, white liquid and white granulation tissue. Acid-fast specimen staining was negative. Hematoxylin and eosin staining showed patches of caseating necrosis and granulomatous inflammation. Gene sequencing subsequent to polymerase chain reaction (PCR) analysis of the ESD specimen identified Mycobacterium tuberculosis (M. TB) DNA fragments. The patient was put on ATT for 6 months.ConclusionPrimary isolated gastric TB of the cardia should be suspected in patients without clinical symptoms whose manifestations are similar to those associated with submucosal tumors. TB-PCR may be helpful for further diagnosis.

The efficacy and safety of laparoscopy combined with gastroscopy positioning in treating gastric stromal tumours: A systematic review and meta-analysis.

Background and Objectives:The objective was to assess the efficacy and safety in treating gastric stromal tumours by laparoscopy combined with gastroscopy positioning surgery.Methods:The randomised controlled trials (RCTs), which are about the efficacy and safety of laparoscopy combined with gastroscopy positioning surgery in treating gastric stromal tumours were searched from the PubMed (1998–1990–2018.6), Wanfang Data (1990–2018.6), China National Knowledge Infrastructure (1979–2018.6) and International Statistical Institute (1998–2018.6). The data were extracted from these trials, and the meta-analysis was made through from RevMan 5.3 software.Results:Six RCTs involving 451 patients were included in the study (227 patients in the laparoscopy combined with gastroscopy positioning group and 224 patients in laparoscopic surgery group). Compared with laparoscopic surgery group, this meta-analysis showed that laparoscopy combined with gastroscopy positioning group could shorten the post-operation hospital stay (P < 0.05) and reduce the intraoperative blood loss (P < 0.05). However, there was no significant difference in others between the two groups, such as operation time (P > 0.05), post-operative time of recovery of intestinal peristalsis (P > 0.05) and the total hospital stay (P > 0.05).Conclusion:Compared with laparoscopic surgery group, the better total effect occurs in laparoscopy combined with gastroscopy positioning group for the treatment of gastric stromal tumours is better. Laparoscopy combined with gastroscopy positioning group for the gastric stromal tumours is acceptable.

Retroperitoneal teratoma misdiagnosed as a gastric stromal tumor: A case report.

The misdiagnosis of retroperitoneal teratoma as a gastric stromal tumor is rarely reported. There are numerous abdominal organs, and retroperitoneal tumors are easily concealed by organs situated more anteriorly on the abdomen; therefore, retroperitoneal tumors are easily misdiagnosed as human digestive system tumors by abdominal surgeons. We herein present the case of a 39-year-old female patient who was diagnosed with a gastric stromal tumor (GST) on preoperative examination, whereas the postoperative diagnosis was retroperitoneal mature cystic teratoma. Such cases are clinically rare. In the present case, the tumor was located in the retroperitoneum, near the lesser gastric curvature, without an obvious gap. The anterior surface of the tumor was concealed by the lesser gastric curvature and did not move significantly with breathing and changes in posture. In such cases, a preoperative misdiagnosis is very likely. The aim of the present study was to improve our understanding of the presentation of retroperitoneal teratomas, thereby gaining more clinical experience and hopefully reducing the rate of misdiagnosis.