Epidemiological, clinical features therapeutic results and evolution of gastrointestinal stromal tumour: about 25 cases.

##plugins.themes.academic_pro.article.main##

O. Hellara
O. Toumi
R. Hadhri
W. Ben Mansour
I. Akkari
A. Moussa
N. Ben Chaabène
H Loghmari
W Melki
F. Bdioui
L. Safer
F. Noomène
A. Hamdi
A Zakhama
H Saffar

Abstract

Background: Gastrointestinal stromal tumors (GIST) are mesenchymal tumors occuring in the majority of cases in the stomach and small intestine, rarely in rectum, colon, esophagus or mesentery. They are derived from cells of cajal or their precursor, and are typically CD117/KIT + (95%), CD34 + (70%). aims: is to study the epidemiological, clinical, therapeutic and evolution of gastrointestinal stromal tumors.

methods: retrospective study including all patientswith the diagnosis of GIST supported in the department of gastroenterology and surgery in universital hospital of Monastir.

results: 25 patients were included, 12 men and 13 women with an average age of 60.5 years. Digestive symptomatology was dominated by gastrointestinal bleeding (n = 12) and abdominal pain (n = 12). The tumor was discovered incidentally in two patients. The small intestine was the most common site of the tumor (n = 10), followed by the stomach in 9 patients, rectum in two patients, the colon (n = 1), the bulb of water (n = 1), duodenum (n = 1) and liver in a patient. The tumor size ranged from 0.8 to 24 cm. GIST was localized in 16 patients, in whom therapeutic care based mainly on surgery and optimal broad. It was metastatic in 9 patients, in whom treatment using imatinib as first-line in 4 of them with a good response in 3 patients and the possibility of R0 surgery in one patient, initial stabilization and then a secondary exhaust in a patient. The first surgery was necessary in 5 patients in complicated situation or if diagnostic doubt.

Conclusion: The best characterization of GIST thanks to advances in cancer research has led to improved treatment of these tumors. Surgery is the standard treatment in localized forms. Imatinib is the standard treatment in metastatic GIST first line as well as adjuvant after surgery

Keywords:

Gastrointestinal stromal tumors, GIST, treatment, im

##plugins.themes.academic_pro.article.details##

References

  1. Xuejiao Hu, Jameson Forster, Ivan Damjanov, PhDPrimary. Malignant Gastrointestinal stromal tumor of the liver. Arch Pathol Lab Med 2003;127:1606-8.
  2. Casella C, Villanacci V, D'Adda F, Codazzi M, Salerni B. Primary extra- gastrointestinal stromal tumor of retroperitoneum. Clin Med Insights Oncol 2012;6:189-97.
  3. Meittinen M, Lasota J. Gastrointestinal stromal tumors : definition, clinical, histological, immunohistochemical and molecular features and differential diagnosis. Virchows Arch 2001;438:1-12.
  4. Meittinen M, Lasota J. Gastrointestinal stromal tumors : definition, clinical, histological, immunohistochemical and molecular features and differential diagnosis. Virchows Arch 2001;438:1-12.
  5. Strickland L, Letson GD, Muro-Cacho CA. Gastrointestinal stromal tumors. Cancer Control 2001;8:252-61.
  6. Miettinen M, Makhlouf H, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J surg Pahol 2006;30:477-89.
  7. Alberini JL, Al Nakib M, Gontier E, cvitkovic F, Rixe O, Rougier P et al. Place de l'imagerie par Tomographie par emissions de positrons pour les tumeurs stromales gastrointestinales. Gastroentérologie Clinique et Biologique 2007;31:585-93.
  8. Monges G, Bisot-Locard S, Blay JY, Bouvier AM, Urbieta M, Coindre JM et al. The estimated incidence of gastrointestinal stromal tumors in France. Results of PROGIST study conductd among pathologists. Bulletin de Cancer 2010;97:10016-22.
  9. Sekkate S, Kairouani M, Abahssain H, Serji B, Boutayeb S, Mrabti Hind et al. Tumeurs stromales gastro-intestinales. La presse médicale 2012 ;41:917-26.
  10. Alecu L, Tulin A, Ursut B, Oproiu A, Obrocea F, Lonescu M. Gastrointestinal stromal tumor with primary hepatic unique location-clinical case. Chirurgia 2011;106:677-81.
  11. Landi B. Place de l'endoscopie dans les GIST. J Chir 2008 :145.
  12. S S E N Rabesalama, A randrianirina, M J Rakotonaivo, A H Rakotoarijoana, H N Rakoto Ratsimba. Hémorragie digestive basse : possibilité d'une tumeur stromale rectale. Rev anesth réanim med urgence 2011;3:18-20.
  13. Landi B, Lecomte T, Cellier C. Tumeurs stromales digestives. Hépato-Gastro 2003;10:187-96.
  14. Rosch T, Lorenz R, dancygier H, Von Wichert A, Classen M. Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors.Scand J Gastroenterol 1992;27:1-8.
  15. Boustieère Ch. Tumeurs stromales du tube digestif: place de l'échoendoscopie et intérêt de la ponction écho-guidée. Acta Endoscopica 2006;36:81-6.
  16. Tumeurs stromales gasro-intestinales (GIST). Thésaurus national de cancérologie digestives 2011.http://www.snfge.com.
  17. JF Emilea, JB Bacheta, S Tabone-Eglingerd, S Brahimia. Histologie et pathologie des tumeurs stromales gastrointestinales. Rev Fr Lab 2008 N°398.
  18. Coindre JM, Emile JF, Monges G, Ranchère-Vince D, Scoazec JY. Tumeurs gastrointestinales : définition, caractéristiques histologiques, immunohistochimiques et génétiques, stratégie diagnostique. Annal pathol 2005;25:358-85.
  19. S Duensing, A Duensing. Targeted therapies of gastrointestinal stromal tumors (GIST) The next frontiers. Biochem Pharmacol 2010;80:575-83.
  20. AP Dei Tos, L Laurino, I Bearzi, L Messerini, F Farinati. Gastrointestinal stromal tumors: the histology report. Dig Liver Dis 2011:S304-9.
  21. CD Fletcher, JJ Berman, C Corless et al.Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-65.
  22. M Miettinen, J Lasota. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70-83.
  23. J Martin-Broto, A Gutierrez, X Garcia-del-Muro et al. Prognostic time dependence of deletions affecting codons 557 and/or 558 of KIT gene for relapse-free survival (RFS) in localized GIST: a Spanish Group for Sarcoma Research (GEIS) Study. Ann Oncol 2010;21:1552-7.
  24. Tardieu M, Dômont J, Cioffi A, Bonvalot S, Le Cesne A. Mise au point sur la prise en charge des GIST. Bulletin du cancer 2010;97:723-31.