Small Bowel Gastrointestinal Stromal Tumors Research Articles

Small Bowel Gastrointestinal Stromal Tumors: The Value of CT Enterography in Assessing Pathological Aggressiveness

Objective This study aimed to characterize the computed tomography (CT) enterography features of the small bowel gastrointestinal stromal tumors (GIST) and to determine the association with pathological aggressiveness. Methods Computed tomography enterography images of 30 patients with the histologically confirmed small bowel GIST were retrospectively enrolled. Tumor size, location, border, growth pattern, enhancement pattern, necrosis, calcification, ulceration, internal air, nodal metastasis, liver metastasis, peritoneal metastasis, and draining vein were evaluated. Relationships between imaging features and pathological aggressiveness were analyzed using χ2 test or Fisher exact test. Correlations among CT features were analyzed using Spearman correlation analysis. Results There were significant differences in tumor size between different risk levels (F = 8.388, P < 0.001). There were statistically significant differences in the 5 imaging manifestations of necrosis, ulcer, tumor boundary, drainage vein, and intratumoral gas (P < 0.05). There was a significant negative correlation between tumor size and enhancement type as well as clear tumor boundary. There was a significant positive correlation between tumor size and necrosis, ulcer, drainage vein, intratumoral gas, liver metastasis, and peritoneal metastasis. Conclusions Some CT enterography imaging features might be useful in the determination of the pathological aggressiveness in the patients with small bowel GIST.

Imaging Gigantic Small Bowel Gastrointestinal Stromal Tumours Through Different Radiological Lenses: A Case Report

Gastrointestinal stromal tumours (GIST) account for 1–3% of all the gastrointestinal (GI) neoplasms. It is the most common mesenchymal tumour in the Gl tract. The majority of GISTs are KIT gene positive; however, it is necessary to diagnose them pre-operatively. Here, the authors report the case of a 65-year-old male who presented with pain and a lump in the umbilical region for the last 2 years. On abdominal ultrasound, there was a heterogeneously hypoechoic mass in the umbilical region, with lobulated margins and central necrotic areas. On small bowel series, the core of the mass showed faint contrast opacification. Contrast-enhanced CT of the abdomen showed a heterogeneously enhancing, lobulated exophytic lesion arising from the small bowel loops, the central core of the lesion demonstrating an air-contrast level. Under ultrasound guidance, the lesion was biopsied. Histopathological findings were suggestive of a spindle cell tumour. The sample was c-KIT positive. Hence, the diagnosis of GIST was confirmed. The patient was given imatinib after resection of the mass. Usually, a GIST of larger size has higher malignant and metastatic potential; however, this article shows a gigantic small bowel GIST with cavitation and heterogeneity in different imaging modality, and still has no metastasis on imaging or high mitotic activity, and nuclear atypia on histopathology. A radiologist should also know the imaging pattern on conventional imaging and ultrasound, apart from usual cross-sectional imaging.

A rare presentation of jejunal GIST: A case report

Gastrointestinal stromal tumors (GISTs) are rare tumors that constitute 1% of all GI tract tumors. Jejunal GISTs are the rarest subtype. We present a middle-aged gentleman, who presented with pain in the right lower abdomen. On abdominal examination, a lump was palpable in the right iliac fossa (RIF). Contrast-enhanced computed tomography of the abdomen revealed an extraluminal soft-tissue mass in the ileum. Computed Tomography-guided core needle biopsy from the lump was consistent with GIST, which was confirmed on immunohistochemistry. Mutation analysis revealed exon 11 mutations. Due to the proximity of GIST to the rectum and urinary bladder, the patient was started on imatinib therapy. After 3 months of treatment, imatinib therapy had to be stopped due to skin reactions. Restaging was done with a positron-emission tomography scan, which demonstrated a soft-tissue mass likely arising from the ileocecal region in the RIF abutting the ascending colon without any significant decrease in size. On exploration, a well-circumscribed mobile extraluminal lobulated mass was seen arising from the antimesenteric border of the jejunum. Histopathologic examination showed GIST, which was confirmed on immunohistochemistry. We report this case to emphasize keeping small bowel GIST as an unusual differential diagnosis of a RIF lump. Furthermore, not all patients can tolerate imatinib treatment, hence exon mutation study is important, and surgery should be considered if it is deemed resectable.

S3991 A Challenging Diagnosis of Small Bowel Gastrointestinal Stromal Tumor at the Ileocolic Anastomosis

S3991 A Challenging Diagnosis of Small Bowel Gastrointestinal Stromal Tumor at the Ileocolic Anastomosis

Novel Genomic Risk Stratification Model for Primary Gastrointestinal Stromal Tumors (GIST) in the Adjuvant Therapy Era.

Traditional risk stratification schemes in gastrointestinal stromal tumors (GIST) were defined in the pre-imatinib era and rely solely on clinicopathologic metrics. We hypothesize that genomic-based risk stratification is prognostically relevant in the current era of tyrosine kinase inhibitor (TKI) therapeutics. Comprehensive mutational and copy-number profiling using MSK-IMPACT was performed. We integrated clinicopathologic and genomic parameters and utilized an elastic-net penalized Cox proportional hazards machine learning model for outcome risk stratification. A 3-tier genomic risk stratification model for recurrence-free survival (RFS) in 152 primary localized gastric and 80 small bowel GISTs was proposed. Gastric GISTs were classified as high risk if chr1p deletion or SDHB loss was present, and intermediate risk if chr14q deletion was present or KIT exon 11 mutation was absent. Small bowel GISTs were classified as high risk if MAX/MGA/MYC, CDKN2A, or RB1 alterations were present, and intermediate risk if chr1p deletion or chr5q amplification was present. Compared with conventional risk stratification, genomic risk stratification both upgrades and downgrades, suggesting that conventional risk stratification may underestimate or overtreat some high-risk and low-risk patients, respectively. Longitudinal sequencing detected most KIT-independent genomic alterations at baseline. Subanalysis in 26 SDH-deficient GISTs revealed that presence of TP53 mutations or chr1q amplifications portends worse RFS and disease-free survival. We developed a novel, next-generation genomic risk stratification model for primary gastric and small bowel GISTs, complementing traditional clinicopathologic models. Future independent validation of our model in external cohorts is essential.

Mortality in small bowel cancers and adenomas – A nationwide, population-based matched cohort study

BackgroundSmall bowel adenocarcinoma (SBA), neuroendocrine tumors (NET) and gastrointestinal stromal tumors (GIST) are neoplastic lesions of the small bowel while small bowel adenomas are precursors of SBA. AimTo examine mortality in patients diagnosed with SBA, small bowel adenomas, NET and GIST. MethodsWe performed a population-based matched cohort study encompassing all individuals with SBA (n = 2289), adenomas (n = 3700), NET (n = 1884) and GIST (n = 509) in the small bowel diagnosed at any of Sweden’s 28 pathology departments between 2000 and 2016 (the “ESPRESSO study”). Each case was matched by sex, age, calendar year and county of residence to up to 5 comparators from the general population. Through Cox regression we estimated hazard ratios (HRs) and 95% confidence intervals (95%CIs) for death and cause-specific death adjusting for education. ResultsDuring follow-up until December 31, 2017, 1836 (80%) deaths occurred in SBA patients, 1615 (44%) in adenoma, 866 (46%) in NET and 162 (32%) in GIST patients. This corresponded to incidence rates of 295, 74, 80 and 62/1000 person-years respectively and adjusted HRs of 7.60 (95%CI=6.95–8.31), 2.21 (2.07–2.36), 2.74 (2.50–3.01) and 2.33 (1.90–2.87). Adjustment for education had a substantial impact on the HR for death in SBA but not for other neoplasias. The predominant cause of excess death was cancer in all groups. ConclusionThis study confirms earlier findings of increased death rates in patients with SBA and NET in a modern study population. We also demonstrate a more than 2-fold increased risk of death in both GIST and the SBA precursor adenoma.

A STUDY ON RETROSPECTIVE ANALYSIS OF GASTROINTESTINAL STROMA TUMOURS.

Introduction:.Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract. They are believed to originate from the interstitial cells of Cajal (ICCs) or from the precursors of ICCs. Most GISTs show an activating mutation in either the c-kit or platelet-derived growth factor receptor alpha (PDGFRA) gene. Tumor size, mitotic rate, and anatomic location correlate with potential malignancy and recurrence rate. The aim of our study is to Aim & Objectivesobserve the demographic and clinical characteristics of GIST in our clinical environment.Method- 30 patients who are diagnosed with GIST managed during the period from Jun 2017 to July 2022 were reviewed in terms of demographics, clinical presentation, location of tumor, characteristics, management, histopathology, IHC analysis, post op follow up & recurrence.The risk stratication in terms of size, mitotic index, site of tumour was observed & classied using modied NIH classication. Results- Out of 30 cases male patient's- 73% (n- 22); female patients27%(n-8). Mean age was 60 years with a range of 44-81 years. Most common clinical presentation was abdominal mass, Abdominal pain. Commonly involved sites are stomach and small bowel.4 cases who underwent multiple organ resection 2 cases developed recurrence in which 1 underwent palliative Whipple's procedure and one was medically managed. GIST Conclusion- s are rare entities with a variety of clinical features, Common sites for GIST are stomach & small intestine. Surgery is the main stay of management in GIST. Neo adjuvant therapy will help in down staging the tumour. Wedge resection & resection &anastomosis will be adequate for stomach in small bowel GIST. En-bloc resection should be considered if adjacent structures are involved. Overall GIST has favourable prognosis if diagnosed early

Small bowel gastrointestinal stromal tumor presenting as a life-threatening emergency

Gastrointestinal stromal tumor (GIST) is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Here in, we present a case of primary small bowel GIST treated at our department. A 58-year-old male patient presented to our emergency department with a diffuse abdominal pain of acute onset. Patient presented with symptoms and signs of acute intestinal obstruction. Imaging studies revealed a mass at mid ileum, with multiple air fluid levels. Intra-operatively, a mass of 12×9 cm was found at mid ileum on antimesenteric border with 3600 volvulus of adjacent ileum. En bloc resection was performed. Histopathology report was suggestive of gastrointestinal stromal tumor.

Effect of tumor location on the efficacy of chemotherapy for gastrointestinal stromal tumors.

790 Background: Gastrointestinal stromal tumors (GISTs) arise from multiple sites within the gastrointestinal tract. Since the introduction of imatinib in 2002, patients have seen improved overall survival. However, a recent National Cancer Database (NCDB) study suggested no survival benefit to adjuvant imatinib for colorectal GIST patients. Another recent study showed that small bowel GISTs have larger median tumor size and higher incidence of tumors with at least 5 mitoses compared to gastric GISTs. These findings suggest a differential tumor biology for GISTs arising from different primary tumor sites, potentially conferring differential response to imatinib. In this NCDB study, we compare overall survival outcomes with and without chemotherapy, stratifying by primary tumor site. Methods: We queried the NCDB from 2004-2018 for patients with GIST histology. We excluded patients with age <40, age>80, high comorbidity score, and patients who received additional therapy other than surgery or chemotherapy. Of the 22,846 patients meeting criteria for our study, 27 patients had tumors originating from the anus, 454 from the colon, 173 from the esophagus, 15,296 from the stomach, 556 from the rectum, 32 from the rectosigmoid junction, and 6,308 from the small intestine. 8,983 (39%) received chemotherapy. Treatment with chemotherapy was used to extrapolate response to imatinib, the mainstay of treatment. Results: Cox proportional hazards analysis demonstrated increased hazard of death for chemotherapy, increasing age, and comorbidity score of 1. Positive predictive factors for survival included female sex and later year of diagnosis. For anal, esophageal, gastric, and rectosigmoid GIST patients, there was no statistically significant overall survival benefit for any treatment modality. For colonic GISTs, neoadjuvant chemotherapy combined with surgery improved overall survival. For rectal GISTs, adjuvant chemotherapy with surgery also provided survival benefit. For small intestinal GISTs, surgery alone or surgery with neoadjuvant, adjuvant, or both neoadjuvant and adjuvant chemotherapy improved overall survival. Conclusions: While our study is retrospective and limited as a NCDB study, our Kaplan-Meier survival analysis demonstrated survival benefit for chemotherapy only in patients with colon, rectal, or small intestinal GIST tumors. Our Cox proportional analysis demonstrated an overall negative survival impact for chemotherapy. These findings lend further support to the idea that differential tumor biology at each primary site may lead to differential response to imatinib. Overall, our study provides rationale for further investigating the heterogeneity of GIST tumor microenvironments, as these differences could contribute to the differential treatment outcomes.

Neurofibromatosis type 1 patient presenting with multiple small bowel gastrointestinal stromal tumors: A case report

Neurofibromatosis type 1 patient presenting with multiple small bowel gastrointestinal stromal tumors: A case report

S2624 Massive Bleeding From Small Bowel GIST Tumor in Young Woman With Neurofibromatosis

Introduction: Gastrointestinal (GI) bleeding can be severe on presentation with associated hypotension and acute anemia. Common causes of upper GI bleeding in young patients include varices, Mallory Weiss tears, peptic ulcer disease, and angiodysplasia. Tumors within the GI tract are a less likely etiology. Here we present a rare case of a young woman with a massive GI bleed from a small bowel Gastrointestinal Stromal Tumor (GIST). Case Description/Methods: The patient is a 24-year-old female who presented to our emergency department with hematemesis, hematochezia, hypotension, increased BUN, acute drop of Hg, and an elevated lactate. After resuscitation with IVF and blood transfusion, she underwent an urgent endoscopy with gastritis, but no active bleeding. While being considered for a colonoscopy, she further decompensated with hemodynamic instability and recurrent hematochezia requiring transfer to the ICU. Urgent CT angiography was performed in an attempt to localize a bleeding source, which revealing an area in the proximal jejunum with extensive hypervascularity in the arterial phase, but no active bleeding (A). Subsequent push enteroscopy showed a large submucosal lesion in mid jejunum with focal ulceration (B, C). She promptly underwent surgical resection and pathology revealed a GIST. On further discussion with the patient’s family, it was later discovered that in the patient’s childhood, she had undergone evaluation for faint and scattered skin lesions suggestive of café au late spots, with work up consistent with Neurofibromatosis 1 (NF1) (Figure 1). Discussion: GISTs are overall uncommon tumors, accounting for only 0.1-3% of all neoplasms in the GI tract. In the general population, GIST tumors are most often discovered in the stomach. However, patients with NF1 have an increased risk for developing multifocal small bowel GISTs. While GI bleeding may be the initial presentation for such lesions, massive bleeding, as seen in this case, is an uncommon presentation. This case reinforces the importance of obtaining a thorough and detailed history to help create a proper differential in our patients.Figure 1.: A, CT angiogram showing hyper-vascular area in jejunum. B, Push enteroscopy showing ulcerated mass in jejunum. C, Push enteroscopy showing mass in jejunum.

S1733 Exceedingly Rare Coexistence of Metamorphosis of Tubulovillous Adenoma of the Ampulla to Adenocarcinoma with Small Bowel Gastrointestinal Stromal Tumor - Case Report and Review of the Literature

Introduction: This is a unique case of a patient with 3 tumors, which include one benign tumor, tubulo-villous adenoma of the ampulla of Vater (TVAoA), and 2 extremely rare malignant tumors, adenocarcinoma of the ampulla of Vater arising from TVAoA and gastrointestinal stromal tumor (GIST) involving the jejunum. Based on literature review, this is the first case of ampullary adenocarcinoma coexisting with GIST. Distal duodenal polyps are uncommon and have preponderance to occur in and around the ampulla of Vater. We report a case of a 77-year-old male who was admitted for painless obstructive jaundice with a 40-pound weight loss over a 2-month period, and who was subsequently diagnosed with 3 tumors. Case Description/Methods: A 77-year-old man was admitted for generalized weakness with associated weight loss of 40 pounds in the previous 2 months and was noted to have painless obstructive jaundice. Computed tomography (CT) of the abdomen and pelvis and magnetic resonance cholangiopancreatography were consistent with a polypoid mass at the level of the common bile duct (CBD) and ampulla of Vater with CBD dilatation. The same lesions were visualized by endoscopic retrograde cholangiopancreatography. Histopathology of endoscopic forceps biopsy showed tubulo-villous AoA (TVAoA). Histopathology of the surgical specimen of the resected ampulla showed adenocarcinoma arising from the TVAoA. Abdominal and pelvic CT also showed a coexisting heterogeneously enhancing, lobulated mass in the posterior pelvis originating from the jejunum (Figure). The patient underwent resection of the mass and jejunojejunal anastomosis. The histopathology of the resected mass confirmed it as a high-grade GIST. Discussion: AoA can occur sporadically and in a familial inheritance pattern in the setting of FAPS. We emphasize screening and surveillance colonoscopy when one encounters AoA in upper endoscopy to check for FAPS. AoA is a premalignant lesion, particularly in the setting of FAPS, that carries a high risk of metamorphism to ampullary adenocarcinoma. Final diagnosis should be based on a histopathologic study of the surgically resected ampullary specimen, and not on endoscopic forceps biopsy.This case is unique because he had 3 tumors and rare coexistence, which included one premalignant TVAoA and 2 malignant tumors: ampullary adenocarcinoma arising from the TVAoA and coexisting jejunal GIST.Figure 1.: Figure1A: CT abdomen and pelvis with contrast. Obstructed distal common bile duct due to a 9 mm polypoid intraluminal (pointed yellow arrows) lesion in the distal CBD. Figure1B: CT of the abdomen and pelvis with contrast. Heterogeneously enhanced lobulated mass with punctate calcifications (pointed yellow arrows) in the posterior pelvis originating from the serosal surface of the pelvic small bowel. Figure1C: Endoscopic retrograde cholangiopancreatography (ERCP) showed abnormal papilla with polypoid mass. Sphincterotomy and deep cannulation procedures were performed and confirmed by fluoroscopy. It showed common bile duct dilatation, and there was an abrupt cutoff at the distal aspect. Figure1D: High-power photomicrograph showing high-grade glandular dysplasia (hematoxylin and eosin stain, 200 X original magnification) Figure1E: A broad base ampullary mass with red fogerty cath was advanced from the cystic duct down through the ampulla to the duodenum. Figure1F: Pedunculated GIST arising from the small bowel approximately 150 cm proximal to the ileocaecal valve.

S3378 Bleeding GIST Treated Successfully With Hemospray in a Patient With Neurofibromatosis Type 1

Introduction: Gastrointestinal stromal tumors (GISTs) are rare subepithelial mesenchymal neoplasms of the gastrointestinal tract that are typically KIT (CD117) positive. GISTs can present with a wide range of symptoms including gastrointestinal hemorrhage. Small bowel bleeding from a GIST can be difficult to treat endoscopically and there is a paucity of data on the use of TC-325 (hemospray) for these tumors. Case Description/Methods: A 47-year-old man with a past medical history significant for neurofibromatosis type 1 and multifocal small bowel GISTs presented to our center with symptomatic anemia. The patient described previous episodes of melena. The patient's initial hemoglobin was 2.2 g/dl. He was initially treated with a transfusion of 4 units packed red blood cells. CT abdomen and pelvis with IV contrast was obtained which revealed a centrally located 6 x 5cm small bowel mass with heterogeneous enhancement and intraluminal signal concerning for active gastrointestinal hemorrhage. A push enteroscopy was performed using a pediatric colonoscope via the mouth and advanced deeply into the small bowel. A large ulcerated submucosal mass with active bleeding was found at the junction of the fourth portion of the duodenum and proximal jejunum. Submucosal injection of 1:10,000 diluted epinephrine around the ulcer base failed to achieve hemostasis. Next, the hemospray catheter was advanced to several centimeters proximal to the bleeding ulcer. Hemospray was deployed and immediate hemostasis was achieved after coating the area. Discussion: The majority of GISTs are sporadic and found in the stomach. Patients with neurofibromatosis type 1 however, have a higher incidence of GISTs, are often multifocal, and most commonly are found in the small intestine as demonstrated here. Endoscopic treatment of small bowel tumor bleeding is challenging because of the location and nature of the bleeding. Conventional treatments such a hemoclips or bipolar electrocautery usually fail to stop tumor bleeding. TC-325 or hemospray is a novel inert powder which accelerates the coagulation cascade leading to rapid hemostasis of actively bleeding lesions. Hemospray should be considered first line treatment for malignant bleeding because of its ease of use, wide field of application and demonstrated success.

Comparison of Computed Tomography Features of Gastric and Small Bowel Gastrointestinal Stromal Tumors With Different Risk Grades.

This study aimed to compare the computed tomography (CT) features of gastric and small bowel gastrointestinal stromal tumors (GISTs) and further identify the predictors for risk stratification of them, respectively. According to the modified National Institutes of Health criteria, patients were classified into low-malignant potential group and high-malignant potential group. Two experienced radiologists reviewed the CT features including the difference of CT values between arterial phase and portal venous phase (PVPMAP) by consensus. The CT features of gastric and small bowel GISTs were compared, and the association of CT features with risk grades was analyzed, respectively. Determinant CT features were used to construct corresponding models. Univariate analysis showed that small bowel GISTs tended to present with irregular contour, mixed growth pattern, ill-defined margin, severe necrosis, ulceration, tumor vessels, heterogeneous enhancement, larger size, and marked enhancement compared with gastric GISTs. According to multivariate analysis, tumor size (P < 0.001; odds ratio [OR], 3.279), necrosis (P = 0.008; OR, 2.104) and PVPMAP (P = 0.045; OR, 0.958) were the independent influencing factors for risk stratification of gastric GISTs. In terms of small bowel GISTs, the independent predictors were tumor size (P < 0.001; OR, 3.797) and ulceration (P = 0.031; OR, 4.027). Receiver operating characteristic curve indicated that the CT models for risk stratification of gastric and small bowel GISTs both achieved the best predictive performance. Computed tomography features of gastric and small bowel GISTs are different. Furthermore, the qualitative and quantitative CT features of GISTs may be favorable for preoperative risk stratification.

Gastrointestinal Cancer and Vaccination Safety during COVID-19 Pandemic

BACKGROUND: During our past 18 months, we must be faced with the current COVID-19 pandemic era with much uncertainty in the continuation of multimodality treatment of the gastrointestinal cancer patients. Especially in this immunocompromised group with the history of previous chemotherapy treatment, these patients have an increased risk of COVID-19 transmission. Many studies have been reported about the current recommendation for gastrointestinal cancer patients during this pandemic, but there might be a lack of evidence about the safety of vaccination for the gastrointestinal cancer patients. AIM: Since the vaccination has been approved by our government medical support, we would evaluate the safety of the COVID-19 vaccination program in gastrointestinal cancer patients. METHODS: All gastrointestinal cancer patients who have been already diagnosed with cancer will be included in this study. The vaccine-related sign symptoms will be recorded and evaluated. The chemotherapy schedule was not been interrupted following the vaccination. The patient who refused to receive the second vaccination dose will be excluded from this study. RESULTS: Thirty-two patients were included in this study (our past 6-month evaluation from February till August 2021), colorectal adenocarcinoma was the most common gastrointestinal cancer according to organ-specific (25 patients), the others were gastric adenocarcinoma, pancreatic adenocarcinoma, and small bowel gastrointestinal stromal tumor. Both of them already received two doses of COVID-19 vaccine during this period, we reported there was no side effect related to these and the chemotherapy cycle has not been interrupted during vaccination. All of the patients could be tolerated it well and did not refuse to continue the treatment. CONCLUSION: There were no significant signs and symptoms of vaccine-related side effects on gastrointestinal cancer patients. COVID-19 vaccination during this pandemic and following the chemotherapy schedule on any kind of gastrointestinal cancer patients was safe and could be suggested as a routine protocol.

Trends and outcomes of minimally invasive surgery for gastrointestinal stromal tumors (GIST).

Minimally invasive surgery (MIS) is increasingly being utilized for the resection of gastrointestinal cancers. National trends for perioperative and oncologic outcomes of MIS for gastrointestinal stromal tumors (GIST) are unknown. We hypothesized that with increased use of MIS, the perioperative outcomes and survival for GIST are preserved. The National Cancer Database (2010-2016) was utilized to assess perioperative and oncologic outcomes for GIST of the stomach and small bowel. Kaplan-Meier method and log rank test were used to compare survival outcomes. Data from 8923 gastric and 3683 small bowel resections were analyzed. Over the study period, MIS became the prevalent modality for gastrectomies (2010: robotic: 2.4%, laparoscopic: 26.1%, open: 71.5% vs. 2016: robotic: 9.6%, laparoscopic: 48.8%, open: 41.6%; p < 0.001), with a smaller increase in enterectomies (2010: robotic: 1%, laparoscopic: 17.3%, open: 81.6% vs. 2016: robotic: 3.9%, laparoscopic: 27.2%, open: 68.9%; p < 0.001). Age and Charlson comorbidity index were similar among groups. MIS approaches were associated with fewer readmissions and lower 90day mortality for gastrectomies and similar rates for enterectomies. MIS did not compromise patient survival even in patients who underwent neoadjuvant treatment or harbored tumors ≥ 10cm. Minimally invasive surgery is increasingly being utilized for resection of gastric and small bowel GIST, with improved postoperative outcomes.In this retrospective review, overall survival after minimally invasive or open surgery was comparable, even in challenging scenarios of neoadjuvant treatment or large tumors (≥ 10cm).

Asymptomatic fecal immunochemical test-negative and positron emission tomography-negative descending colon cancer concomitant with small bowel gastrointestinal stromal tumor detected by abdominal ultrasonography during a health checkup: A Case Report

Asymptomatic fecal immunochemical test-negative and positron emission tomography-negative descending colon cancer concomitant with small bowel gastrointestinal stromal tumor detected by abdominal ultrasonography during a health checkup: A Case Report

Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions

To analyze the issue of gastrointestinal stromal tumors (GISTs) and potential of minimally invasive surgical interventions. We analyzed postoperative outcomes in 97 patients with gastric and intestinal GISTs who underwent surgical treatment at the National Medical Research Centre for Oncology between 2015 and 2020. Twenty (24.7) patients with gastric GISTs underwent laparoscopic partial and distal gastric resections. Five (35.7%) patients with GISTs of the small intestine underwent minimally invasive segmental bowel resections. Only minimally invasive interventions were performed in patients with rectal GISTs. Analysis of laparoscopic and open surgeries for GISTs found no significant differences. Analysis of laparoscopic and open surgeries for gastric and small bowel GISTs revealed the obvious advantages of minimally invasive access regarding postoperative outcomes. Indeed, we found no need for nasogastric drainage in 50% of patients (p<0.001), earlier recovery of intestinal motility and oral feeding (p<0.001), lower postoperative morbidity (p=0.036), fast recovery of motor activity (p<0.001) and shorter postoperative hospital-stay (p<0.001). Despite small incidence, GISTs are a complex problem in modern oncology. Diagnosis and treatment require a multidisciplinary medical team (morphologists, geneticists, radiologists, surgeons, chemotherapists, gastroenterologists and other specialists) that is possible in a reference center. Minimally invasive interventions for GISTs of the stomach, small intestine and rectum improve postoperative course.

A gastrointestinal Stromal Tumor of the Small Bowel Presenting as an Acute Peritonitis: A Case Report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, GISTs of the small bowel presenting as an acute peritonitis are rare, which necessitates emergency surgery.&#x0D; Presentation of Case: A 44-year-old women presented with severe abdominal pain and nausea. Physical examination revealed a tenderness and muscular defense around the lower abdomen. Laboratory data showed an elevated white blood cell count and C-reactive protein level. An enhanced computed tomography (CT) scan showed a 8 × 10 cm cystic mass in the lower abdomen, which contained air. Emergency laparotomy showed a giant perforated tumor that arose from the ileum, the tumor and affected segment of ileum were resected. the tumor was diagnosed as GIST in low-risk category, and imatinib mesylate was initiated, The patiente had an uneventful postoperative course and remains well.&#x0D; Discussion and Conclusion: Such rare cases can be diagnosed and treated properly with careful clinical evaluation, Computed tomography (CT) is the gold standard for imaging that is used to characterize any abdominal mass. Surgical resection is still the first-line treatment for patients with primary localized and resectable small bowel GIST and adjuvant chemotherapy with imatinib mesylate is indicated in patients with high-risk small bowel GIST.

Synchronous Schwannoma and Gastrointestinal Stromal Tumor in Small Intestine – A Rare Case

Abstract Introduction/Objective Small bowel Schwannoma is a benign neoplasm of nerve sheath cells. The Gastrointestinal stromal tumor (GIST) constitutes only about 1-2% of small bowel spindle cell tumors. The simultaneous presence of two tumors in the small bowel is extremely uncommon. Methods/Case Report We report a case of small bowel GIST co-existing with Schwannoma. A 64-year-old female with a known history of Neurofibromatosis was admitted for excision of a small bowel tumor. MRI of the abdomen revealed two enhancing lesions in the left upper quadrant adjacent to the small bowel. Differential considerations included GIST versus Neurofibroma. Left hemicolectomy with small bowel resection was performed. The proximal small bowel revealed GIST, spindle cell type, low risk (3.5 cm), low grade (&amp;lt;5 mitoses/ 5mm2). Tumor cells were diffusely reactive to CD34, CD117, and DOG1 immunostains and were nonreactive to S100 and SOX10 immunostains confirming the diagnosis of GIST. Another segment of the small bowel revealed a 1.5 cm well-circumscribed, predominantly spindle cell tumor with abundant myxoid stroma and prominent cyst formation. Tumor cells were diffusely reactive to S100 and SOX10 immunostains but nonreactive to CD34, CD117, and DOG1, favoring a diagnosis of Schwannoma. Gastrointestinal Schwannomas may be associated with Neurofibromatosis in some cases. GIST, a KIT- or PGDFRA-signaling driven mesenchymal tumor has also rarely been reported to be associated with Neurofibromatosis type 1. However, synchronous small bowel Schwannoma and GIST represent a rare co-existence of two different histopathologic subtypes of spindle cell tumors. Results (if a Case Study enter NA) NA Conclusion In summary, we present the rare co-existence of two different spindle cell lesions in Neurofibromatosis patient.