Mesenchymal Tumors Of Gastrointestinal Tract Research Articles

Prediction of Pathological Risk Stratification using Computed Tomography Features in Gastrointestinal Stromal Tumours: A Retrospective observational Study

Introduction: Gastrointestinal Stromal Tumours (GISTs) are the most common mesenchymal tumours of gastrointestinal tract. A high postsurgical recurrence and metastatic rate have created a need for a presurgical risk profile identification system. Aim: To assess the association between morphological Computed Tomography (CT) parameters with the pathological risk profile and analyse which CT features can predict the risk grading of GISTs. Materials and Methods: This was a retrospective cohort study based on imaging and histopathological data of 26 patients with pathologically proven GISTs presenting to the Department of Radiodiagnosis of a tertiary hospital in the northern Indian Himalayan foothills over a period of five years from July 2018 to June 2023. CT imaging features including size, growth pattern, margins, enhancement, calcifications, necrosis, intralesional haemorrhage, enlarged feeding vessels, direct organ invasion, and associations such as ascites and lymphadenopathy were studied. All lesions were classified as per Miettinen risk classification into no risk, very low-risk, low, moderate, and high-risk lesions. Analysis was done by the Chi-square test. Predictive analysis was carried out by computing the odds ratio and performing regression analysis on significantly associated imaging features. Results: Out of 26 patients, the study group comprised 16 males (61.54%) and 10 females (38.46%). The most common decade of presentation was the 6th decade with the mean age of presentation being 55.81±4.23 years. Twelve patients were grouped under intermediate to high-risk grading. Lesion size >5 cm (p-value=0.0171, OR=19.12), ill-defined margins (p-value=0.0048, OR=18.33), intralesional necrosis (p-value=0.0053, OR=19.8), and enlarged feeding vessels (p-value=0.012, OR=21.27) were identified as imaging features with significant association and predictive ability for high-risk lesions. The strongest predictive ability for a high-risk profile was shown by ill-defined margins (R2 =0.381) and intralesional necrosis (R2 =0.3287). Conclusion: A preoperative Contrast Enhanced Computed Tomography (CECT) assessment provides a comprehensive imaging profile for GISTs as well as a fair accuracy of risk profile prediction via various singular and clustered morphological parameters.

Immunotherapy of gastrointestinal stromal tumors: current view and future directions

Gastrointestinal stromal tumors (GIST) are most common mesenchymal tumors in gastrointestinal tract which originate from interstitial cells of Cajal and characterized by the mutations in the KIT or PDGFRA tyrosine kinase receptors. Thus, the common therapeutic approach for GIST therapy (including metastatic, recurrent and non-resectable forms) is based on inhibiton of activities of receptor tyrosine kinases indicated above by corresponding receptor tyrosine kinase inhibitors, including first-line therapeutic agent imatinib mesylate – Gleevec. Despite of high efficacy of IM-based therapy, most of GIST patients acquire resistance to this receptor tyrosine kinase inhibitor, which in turn requires second-, third- and fourth-line therapies. The review also describes the common molecular and genetic variants of GIST and the mechanisms of primary and secondary GIST resistance to the targeted-based therapies. In addition, the role of immune microenvironment in GIST and its relationship with tumor’s mutational burden are discussed in detail, thereby illustrating the immunotherapy as one of the attractive future directions for GIST therapy. Lastly, the manuscript provides the information about the ongoing clinical trials of GIST immunotherapy.

Unusual breast metastasis of gastrointestinal stromal tumor: A case report and literature review

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of gastrointestinal tract. The most common sites of metastases are the liver and the peritoneum, whereas breast metastases from GIST are extremely rare. We present a second case of GIST breast metastasis. We found a case of breast metastasis from rectum GIST. A 55-year-old female patient presented with rectum tumor with multiply liver lesions and metastasis in the right breast. Abdominal-perineal extirpation of rectum was performed, histology and immunohistochemistry study showed GIST, mixed type with CD117 and DOG-1 positive staining. The patient was taking imatinib 400 mg for 22 mo with stable disease. Because of growth of the breast metastasis the treatment was changed twice: The dose of imatinib was doubled with further progression in the breast lesion and then the patient was receiving sunitinib for 26 mo with partial response in the right breast and stable disease in the liver lesions. The breast lesion increased and right breast resection was done - surgery on local progression, the liver metastases were stable. Histology and immunohistochemistry studies revealed GIST metastasis, CD 117 and DOG 1 positive with KIT exon 11 mutation. After surgery the patient resumed imatinib. Until now the patient has been taking imatinib 400 mg for 19 mo without progression, last follow up was in November 2022. GISTs breast metastases are extremely rare, we described the second case. At the same time second primary tumors have been reported frequently in patients diagnosed with GISTs and breast cancer is one of the most common second primary tumors in patients with GISTs. That is why it is very important to distinguish primary from metastatic breast lesions. Surgery on local progression made it possible to resume less toxic treatment.

Ileo Colic Intussusception Secondary to Primary Intestinal Tumour: A case report

Intussusception is defined as invagination of bowel within adjacent segment. Invariably it is the proximal into distal bowel it is commonly seen in child between 3-9 month, very rarely it is seen in adults. Child to adult ratio is 20:1. Most common cause in adult is associated with a lead point which is usually a polyp, sub mucosal lipoma or tumor (GIST). Intussusception Colo colic is most common. And thereafter comes ileocolic. A gastro intestinal stromal tumor (GIST) is Defined as spindle epithelioid or occasionally pleomorphic mesenchymal tumors of gastrointestinal tract that expresses the KIT protein and approximately 2% of all neoplasm of the gastro intestinal tract is classified as GIST.

Clinico-Histomorphological Spectrum and CD34 in Gastro-Intestinal Stromal Tumours: An Experience from Tertiary Care Centre, Kolkata, India

Introduction: Gastrointestinal Stromal Tumours (GISTs) are an important subcategory of mesenchymal tumours of gastrointestinal tract. The discovery of c-kit mutation in a subset of GIST has made amenable the treatment of this entity by targeted therapy. Although, Cluster of Differentiation 34 (CD34) is a well established marker aiding in diagnosis of GIST, recent development of novel markers like Discovered on GIST1 (DOG1), CD117 have undermined its value. Still it’s a frequently used marker in the resource poor settings. Aim: To study the expression of CD34 immunomarker with respect to site, grade, stage, histomorphological type and risk category of GIST specimens received in the stipulated time period. Materials and Methods: An observational retrospective crosssectional was conducted in the Department of Pathology at R G Kar Medical College and Hospital, Kolkata, West Bangal, India. The duration of the study was three years and 11 months, from September 1, 2019 to August 31, 2022. All the samples diagnosed as GISTs within the study period, were taken from the received specimens in the department and immunohistochemical examination was done on the selected samples using monoclonal antibodies against CD34 after obtaining thin sections from formalin fixed paraffin embedded blocks and retrieval of antigen. The data was interpreted by light microscopy using a semiquantitative method with respect to prefixed parameters, where 50% proportional positivity of CD34 in the tumour cells was considered as positive. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Mean age of the study participants was 49.78 years. A total of 8 (34.7%) cases originating from stomach and 13 (56.5%) from intestine. Eight out of 23 (34.7%) cases showed positive expression of the marker. Six out of eight cases of gastric GISTs were found to be positive and 66.6% cases of high grade GISTs were positive for CD34. Statistically significant association was found between expression of CD34 and the site of tumour;-GISTs arising from stomach, particularly of spindle cell type, showing strong expression (p=0.003). It was found that, high grade GISTs are more likely to be positive for CD34. None of the epithelioid GISTs have shown positivity, neither any significant association was evident between expression of this marker with tumour stage or risk category. Conclusion: GISTs arising from stomach, particularly of spindle cell type, are more likely to show strong CD34 expression. Higher grade GISTs were found to be associated with positive CD34 expression in the present study, but no significant association was evident between expression of this marker.

1*, 1, 1

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of gastrointestinal tract with different expressions of CD117 (transmembrane KIT receptor tyrosine kinase) from other related tumors, which provides insights into the disease management of GIST. Tyrosine kinase inhibitors reduce the incidence of tumor recurrence and make the tumor resectable. Despite the malignant potential of GISTs, gastric GIST shows a better prognosis versus GISTs at other locations. Contrast-enhanced computed tomography (CECT) is considered the radiological diagnosis of choice because biopsy increases the risk of bleeding and tumor spreading. In addition to surgical resection which remains the mainstay of GIST treatment, active surveillance is also available for gastric tumor with a size <2cm. Currently, given the clinical consensus of an increased response of the tumor to chemotherapy after resection of the advanced lesion, patients with metastasis are also indicated for cytoreductive surgery. Various minimally invasive techniques including endoscopic (endoscopic band ligation, endoscopic muscularis dissection, endoscopic submucosal dissection, endoscopic submucosal tunnelling, endoscopic full-thickness resection), laparoscopic and combined techniques (laparoscopic endoscopic cooperative surgery, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique) have been developed for surgical resection of tumors. Due to the high recurrence rate even during treatment, patients receive a physical examination and CECT follow-up every 3-5 months for 5 years followed by annual visits.

Study from Tertiary Care Centre Elucidating the Role of CD 117 & DOG 1 Antibodies in Diagnosis of Gastrointestinal Stromal Tumors

Introduction: Gastrointestinal stromal tumors are the most common mesenchymal tumors in the gastrointestinal tract. The diagnosis of GISTs becomes much more accurate by using IHC (CD117/DOG1) and molecular analysis (KIT/PDGFRA), both of which constitute the gold standard of diagnosis in GISTs. Aim: The study was conducted in a tertiary care hospital in western India between January, 2019 to June 2020 to evaluate clinic pathological correlation & agreement between CD117 and DOG1 antibodies that are employed in diagnosis of GIST. Material & Methods: The cases were selected on the basis of inclusion & exclusion criteria defined and thereafter a panel of CD117, DOG1 and other antibodies was applied to diagnose GIST from other mesenchymal tumors of gastrointestinal tract. Results: The average age of the patient was 53.5 years with male preponderance was noted. (M:F=1.66). The clinical complaints included: GI Bleeding (50%), Abdominal pain (30%), lump abdomen (20%).Most common site for GIST was gastric (50%) followed small intestine (40%), mesentry-omentum (7.50%) and colon (2.50%). Spindle cell morphology (75.00%) was the most common histomorphological subtype. DOG1 antibody diagnosed 97.50 % cases of GIST and CD117 diagnosed 92.50% cases of GIST. DOG1 expressed high staining ratio score in 95% cases while CD117 had high staining ratio score in 87.50% cases. Mostly stronger intensity of immunostaining was observed with DOG1 while CD117 expressed variable intensity of immunostaining. Also, CD117 expressed variable immunostaining amongst different histomorphological variants and risk groups. While immunostaining with DOG1 was not significantly variable. The results demonstrated that DOG-1 was found to be a superior marker with higher sensitivity and specificity as compared to CD117, specificity (100% versus 96.43%) and sensitivity (97.5% versus 92.5%). Conclusion: The immunohistochemistry panel should be applied in stepwise manner over “morphologically suspicious” cases Mesenchymal Tumours of GIT to diagnose and rule out GIST with first panel being CD117 and DOG1. DOG-1 was found to be a superior marker with higher sensitivity and specificity as compared to CD117. Cases negative for all the antibodies should definitely be referred for molecular analysis to detect other mutations of GIST (kit/PDGFRA negative wild type GIST). Keywords: GIST, CD 117, DOG 1 antibody

Study of Histomorphological Spectrum of Mesenchymal Tumors of GIT at Tertiary Care Centre

Introduction: Mesenchymal neoplasms of gastrointestinal tract are a group of rare tumors with overlapping histological features. There is significant morphologic overlap among diagnostic entities on the differential of mesenchymal lesions. So, use of a panel of immunohistochemical antibodies is necessary for accurate characterization of mesenchymal lesions of gastrointestinal system. Aim: The study was conducted in a tertiary care hospital in western India between January, 2019 to June 2020 to study the histomorphological spectrum and utility of IHC in the final diagnosis of mesenchymal tumor of GIT. Material & Methods: The cases were selected on the basis of inclusion & exclusion criteria defined and thereafter a panel of IHC antibodies was applied to diagnose mesenchymal tumors of gastrointestinal tract. Results: The study included 92 cases with a clinical and provisional morphologic diagnosis of mesenchymal tumors of GIT, mesentery and omentum. 25.00% cases of MT of GIT and were diagnosed on morphology alone. While, 75.00% required IHC for final diagnosis. Tumors with spindle cell morphology 61.95%, epithelioid cell morphology 5.80%, with mixed (spindle+epithelioid) cell morphology 10.14% and pleomorphic cell morphology 1.45%. Using” WHO 2013 of soft tissue tumors” MT of GIT were classified according to clinical behavior in to Benign tumors in 44.57% cases, lipoma being the commonest tumour diagnosed 34.15% cases. Intermediate tumors in 8.70% cases, all cases 100% being fibromatosis. Malignant tumors in 46.74% cases. Using “WHO 2019 of MT of Digestive System”, tumors were classified based on cell type. The commonest phenotype was “GIST” with 42.39% cases, followed by the second common phenotype “Adipose and Myofibroblastic tumor” with 33.69% cases, “Smooth and Skeletal Muscle tumors” with 9.78% cases. “Neural Tumors” with 7.63% cases, “Vascular and Perivascular” with 5.43% cases. Conclusion: GIST are the commonest MT of GIT. The availability of targeted chemotherapy warrants confirmation and ruling out GIST amongst all MT on priority basis. IHC panel should be applied in stepwise manner over “morphologically suspicious” cases Mesenchymal Tumors of GIT to diagnose and rule out GIST with first panel being CD117 and DOG1. These optimize the use of antibodies and make it cost effective. Keywords: Mesenchymal tumors, GIST, CD 117, DOG 1 antibody

Case report: successful treatment of a rare large jejunal gastrointestinal stromal tumour with surgery and using principle of short-term fasting

Small intestinal gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours of gastrointestinal tract comprise 0.04% of small intestinal neoplasms. We presented a case of 61 years female presenting in emergency with pain in epigastrium, multiple episodes of vomiting, raised total leucocyte counts. CECT abdomen showed a large non-enhancing jejunal lesion. The patient had emergency small bowel resection and anastomosis. Postoperative patient started on imatinib and kept on short-term fasting. This case report highlights the rare presentation of jejunal GISTs, successful surgical outcome and good enhancing effect of short-term fasting on chemotherapy.

Rare case of giant extra gastrointestinal stromal tumor of wild variant

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of gastrointestinal tract. The interstitial cells of Cajal (pacemaker cells) act as normal counterpart of tumor. They are rare cancers with incidence of 1.5 in 100000. KIT and PDGFRA gene mutations are the most common pathogenetic causes, whereas a minority of GISTs do not harbour either of the mutations, referred to as wild type GISTs. A minority of cases are extra gastrointestinal (EGIST), arising from mesentry, omentum and retroperitoneum. We present a wild type EGIST measuring 32×24×15 cm and weighing approximately 6 kg.

A novel fusion between CDC42BPB and ALK in a patient with quadruple wild‐type gastrointestinal stromal tumor

BackgroundGastrointestinal stromal tumors (GISTs) are the most common type of mesenchymal tumor in gastrointestinal tract, with striking features of morphology and immunohistochemistry. But GISTs in pregnancy could seldom be found. Pathogenic activating mutations of the proto‐oncogene KIT and PDGFRA are detected in majority GISTs, and adjuvant imatinib therapy targeting KIT and PDGFRA mutations is recommended for patients with high‐risk GIST. However, some rare subgroups with distinct molecular features remain uncovered and more therapeutic targets need to be revealed.MethodsThe DNA/RNA samples were detected using the NGS‐based YuanSu450 gene panel. After identifying the CDC42BPB‐ALK fusion by NGS, this novel fusion was further confirmed by Sanger sequencing. Subsequently, FISH analysis was performed using the Vysis ALK Break Apart FISH Probe kit to testify the ALK status. ALK protein expression was confirmed by IHC (D5F3 and 5A4).ResultsHerein, we reported the first case of quadruple wild‐type (WT) GIST with ALK‐CDC42BPB fusion and ALK (D5F3) overexpression. In this study, we described a 33‐year‐old pregnant patient in lactation who had a massive space occupying lesion (with the maximum diameter of 22 cm) in the stomach and was eventually diagnosed as quadruple WT GIST (KIT WT/PDGFRA WT/SDH WT/RAS‐P WT).ConclusionWe unexpectedly found that this GIST patient showed ALK (D5F3) overexpression and harbored a novel fusion CDC42BPB exon 24‐ALK in exon 20.

Malignant extragastrointestinal stromal tumor: A challenging diagnosis due to unusual presentation

Gastrointestinal stromal tumors are the most common mesenchymal tumors of gastrointestinal tract which comprise <1% of all primary gastrointestinal malignancies. These tumors show mutations in the KIT gene or platelet-derived growth factor receptor-A gene and usually stains positively for CD117. Very few cases of extragastrointestinal GIST (EGIST) have been reported in literature which originate from omentum and mesentery as per our knowledge. Here, we report a case of EGIST arising from omentum with no connection to gastrointestinal tract organs in a 60-year-old woman who presented with abdominal pain for 2–3 months. Intraoperative findings showed the presence of multiple globular masses and nodules in the peritoneal cavity. Microscopically, the spindled tumor cells were arranged in interlacing fashion. Immunohistochemistry showed positivity for CD117 and negativity for smooth muscle actin (SMA). Thus, EGIST should always be considered as a differential diagnosis for nodular mesenteric masses.

Mesenchymal Tumors in Gastrointestinal Tract

Mesenchymal neoplasms arising in the digestive tract are rare compared to adenomas and carcinomas [1]. They include several entities with histomorphological similarity and immunohistochemistry helps to confirm the diagnosis [2]. Our goals are to study the epidemiological aspect of mesenchymal tumors, and to compare the histological diagnoses before and after the use of immunochemistry. This is a retrospective, descriptive, single-center study performed on all cases of mesenchymal tumors in gastrointestinal tract, diagnosed at the laboratory of Pathological Anatomy Unit of Joseph Ravoahangy Andrianavalona University Hospital from January 1, 2007 to December 31, 2018. We included 29 cases. The mean age was 43.28 years. The sex ratio was 1.07. After immunohistochemical examination, 24.14% of tumors changed diagnosis to GISTs which are the most common mesenchymal tumor involving the gastrointestinal tract. In all cases of mesenchymal tumors of the gastrointestinal tract GIST should first be ruled out before making other diagnoses. Histologic and immunophenotypic features are thereby essential. According to the literature review, if c-Kit and DOG-1 are negative, molecular biology must be used.

Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

The aim. To clarify all most important immunohistochemical features of gastrointestinal stromal tumors with different histological patterns and analyze the role of expression of Ki-67, MMP-9, VEGF and p16ink4A as a predictive markers of tumor progression.&#x0D; Materials and methods. The study is based on analysis of 100 primary GISTs for description of their morphological features and 36 GISTs taken from this 100 for study of prognostic markers.&#x0D; Results. All spindle cell GISTs have shown diffuse expression of CD117 in tumor cells. The levels of CD117 expression varied from strong expression (3+) until mild expression (1+). Strong expression were seen in 75,8 % of spindle cell GISTs. Epithelioid GISTs demonstrated heterognous moderate or mild expression of CD117. All primary epithelioid GISTs from patients that had relapse of tumor in period from 1 till 3 years demonstrated focal mild expression of CD 117 in tumor cells. Expression of DOG-1 were seen in all 100 cases of GISTs, that were included in our study. The strong expression of DOG-1 (3+) were seen in all 45 GISTs that had low mitotic rate (≤5 mitoses per 50HPF) and not associated with their histological pattern. GISTs with high mitotic rate demonstrated heterogeneous expression of DOG-1 in tumors: moderate expression (2+) with patchy areas of strong expression (3+). Expression of CD56 was not found in spindle cell GISTs, but single tumor cells of epithelioid GISTs that had high mitotic rate demonstrated expression of this marker. The average expression of p16ink4A were higher in tumors that gave relapses compared with tumors without relapses (50,3 % versus 5,7 % respectively, U-test=16.5; p≤0,01).The average expression of MMP-9 also were significantly higher in GISTs that gave relapses: 63,2 % compared with 13,4 % in GISTs without relapse (U-test=16; p≤0 ,01).The strong VEGF expression was found in 66,7 % of GISTs that had relapses and only in 8,3 % of GISTs without relapses. 50 % of GISTs without relapses was negative for VEGF. Finally, the average expression of Ki-67 were 13,4 % in GISTs with relapses and 8,7 % in GISTs without them (U-test=16; p≤0,01).&#x0D; Conclusion. We highly recommend using DOG-1 for epithelioid GISTs. Additionally in epithelioid GISTs can be used CD56 that can give focal positive reaction in some tumour cells. The following minimal panel of markers for differential diagnosis of spindled GISTs from other mesenchymal tumors of gastrointestinal tract is proposed: CD117, DOG-1 and SMA, where the first too markers will demonstrated the moderate or strong diffuse expression and SMA can be occasionally positive in some tumor cells. p16ink4A, ki-67, VEGF and MMP-9 can be used as additional prognostic markers in GISTs.

Incidence of gastrointestinal stromal tumor in Chinese urban population: A national population-based study.

BackgroundInformation on incidence of gastrointestinal stromal tumor (GIST), the most common type of mesenchymal tumor in gastrointestinal tract, was limited in China. This study aimed to estimate the incidence of GIST in urban population from mainland China in 2016.MethodsUrban Employee Basic Medical Insurance (UEBMI) and Urban Residence Basic Medical Insurance (URBMI) in China were used. The denominator of incidence was the total person‐years of insured individuals in 2016 in the database, covering approximately 0.43 billion individuals. The numerator was the number of incident GIST cases in 2016.ResultsThe crude incidence in 2016 was 0.40 per 100,000 person‐years (95% CI, 0.06–1.03). Male incidence was higher than female incidence (0.44 vs. 0.36, rate ratio: 1.22, p < 0.001). The mean age at diagnosis was 55.20 years (SD = 14.26) and the incidence among those aged 50 years or older was 2.63 times (0.84 vs. 0.32, p < 0.001) higher than those aged under 50. The highest incidence was observed in East China (2.29, 95% CI: 0.46–5.54).ConclusionsThe incidence of GIST in mainland China was lower than Europe, North America and Korea. The mean age at diagnosis of GIST in China was younger than that of Europe and Canada. This study provides useful information to further research, policy formulating and management of GIST.

Malignant GIST DOG-1 Positif Pada Colon Dengan Metastasis Pada Jaringan Paraovarium Dan Cairan Asites

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of gastrointestinal tract that originate from Interstitial Cell of Cajal (ICC). The correct diagnosis of GISTs is important for therapeutic reasons of imatinib. Recently, DOG-1 has been introduced as an important diagnostic marker with high sensitivity and specificity. We report a caseof 40 years old woman with pain and swollen stomach in left lower quadrant since four month before come to the hospital. Ultrasound examination showed hipoechoic lession in the posterior of uterus and ascites. Paraovarian mass attached to the transverse colon and ascites was found on surgery. Histopathology diagnosis was a mesenchymal stromal tumour suggestive malignant GIST. Citological examination of asites fluid show a malignancy metastases. Immunohistochemistry showed negative for c-kit and positive for DOG-1, the conclusion is a GIST. Immunohistochemistry examinations are important to make defenitive diagnosis for GIST. C-kit-negative GIST sare still rare, but defenitive diagnosis must be made because related to target therapy. DOG 1 has been proven in 89% of c-kit-negative GIST and claimed more sensitive and spesific. Keywords: GIST, c-kit, DOG-1, ICC, paraovary

Malignant GIST DOG-1 Positif Pada Colon Dengan Metastasis Pada Jaringan Paraovarium Dan Cairan Asites

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of gastrointestinal tract that originate from Interstitial Cell of Cajal (ICC). The correct diagnosis of GISTs is important for therapeutic reasons of imatinib. Recently, DOG-1 has been introduced as an important diagnostic marker with high sensitivity and specificity. We report a caseof 40 years old woman with pain and swollen stomach in left lower quadrant since four month before come to the hospital. Ultrasound examination showed hipoechoic lession in the posterior of uterus and ascites. Paraovarian mass attached to the transverse colon and ascites was found on surgery. Histopathology diagnosis was a mesenchymal stromal tumour suggestive malignant GIST. Citological examination of asites fluid show a malignancy metastases. Immunohistochemistry showed negative for c-kit and positive for DOG-1, the conclusion is a GIST. Immunohistochemistry examinations are important to make defenitive diagnosis for GIST. C-kit-negative GIST sare still rare, but defenitive diagnosis must be made because related to target therapy. DOG 1 has been proven in 89% of c-kit-negative GIST and claimed more sensitive and spesific.Keywords: GIST, c-kit, DOG-1, ICC, paraovary

Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases.

Title: Laparoscopic Multivisceral Resection of Gastrointestinal Stromal Tumor Post Neoadjuvant Imatinib Therapy: A Series Of Two Cases. Introduction: Gastrointestinal stromal tumor is the most common mesenchymal tumor of gastrointestinal tract. Surgery is the cornerstone of management. Targeted chemotherapy viz. Imatinib, sunitinib, regorafenib had reported to be useful in locally advanced cases for downstaging. Here we are presenting two cases, one was arising from the stomach another from tail of the pancreas. Both were successfully managed by laparoscopic multivisceral resection of gastrointestinal stromal tumor after downstaging of tumors. Case report 1: A 47 years old male presented with postprandial fullness and early satiety for 8 months associated with on an off episode of melena. His general, physical and abdominal examination was unremarkable. Endoscopy revealed, normal gastric mucosa with an extrinsic bulge. USG abdomen and CECT revealed a heterogeneously enhancing lesion probably arising from the greater curvature of the stomach and abutting spleen and pancreas. Neoadjuvant therapy started in view of locally advanced disease. He underwent laparoscopic sleeve resection of gastric GIST with distal pancreatico-splenectomy. After a year follow up, no signs of recurrence seen. Case report 2: A 64 years old male presented with dyspepsia and postprandial fullness for 2 years with no history of melena. He also had a loss of appetite and weight. UGI endoscopy revealed extrinsic compression with normal mucosa. USG abdomen and CECT revealed a 17.2 x 11 x 10.5 cm solid cystic lesion abutting greater curvature of the stomach and extending up to splenic hilum and effacing pancreas. In view of locally advanced disease he received imatinib for 1 year followed by laparoscopic distal pancreaticosplenectomy. On six months follow up he is doing well. Conclusion: Gastrointestinal stromal tumor is a rare mesenchymal tumor that has metastatic potential. Open surgery is the preferred view to avoid spill and positive resection margins. Here both patients were managed by multivisceral resection, laparoscopically. Though there is a dearth of literature regarding laparoscopic surgery. However, it is feasible in experienced hands.

Clinicopathological and immunohistochemical study of gastrointestinal stromal tumours: A series of 46 cases from a single institution

Clinicopathological and immunohistochemical study of gastrointestinal stromal tumours: A series of 46 cases from a single institution - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.126, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Synchronous Adenocarcinoma and Gastrointestinal Strom al Tumour (GIST) of the Stomach

Gastrointestinal stromal tumours are rare mesenchymal neoplasms of gastrointestinal tract with a malignant potential and unpredictable behavior and stomach is the commonest location involved. However coexistence of gastric carcinoma and GIST is very rare. A 32- year-old male patient who presented with upper abdominal dyspeptic symptoms, was evaluated with Upper GI Endoscopy which revealed an ulcerated lesion in the antral part of the stomach. Biopsy was taken and histopathological examination revealed the lesion as poorly differentiated adenocarcinoma. Distal radical gastrectomy revealed another 3cm of submucosal mass of GIST along with the existing adenocarcinoma.&#x0D; Journal of Surgical Sciences (2015) Vol. 19 (1) : 31-34