Prognosis of gastrointestinal stromal tumors.

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors (GIMT) of the gut. The aim of this retrospective study is to correlate the histological risk factors with the survival of our patients operated for GIST. METHODOLOGY: In our department, from 1980 to October 2003, 15 patients were operated for GIST. Their mean age was 58 years old and 8 of them were males; 10 (67%) were localized in the stomach and 5 (33%) in the small bowel. In 7 cases liver metastases were present at laparotomy and 4 of them also had peritoneal diffusion. We performed immunohistochemistry for c-Kit, SMA and S100p. Mitotic index (MI) and size neoplasm were the main pathological criteria for malignity. The patients with c-kit (CD117) positive neoplasms were divided according to NIH Consensus Conference risk class, MI, tumor size, localization, SMA or S100p presence, liver metastasis and peritoneal metastasis to compare the different 5-year survival rates. Survival analysis was performed using Kaplan-Meier method and log-rank test and a p < 0.05 was considered as significant. RESULTS: Global survival rate after 5 years was 40% and the mortality was, in all cases, due to GIST. In our experience gender, age, tumor size, localization and S100p positivity did not play any role in predicting the prognosis of GIST. On the contrary high MI and SMA positivity are significantly associated to a lower survival rate (33% vs. 86% and 39% vs. 100% at 5 years, respectively). Finally patients with metastases at laparotomy have a significantly lower 5-year survival rate (hepatic 29% vs. 100%, hepatic and peritoneal 25% us. 78%). CONCLUSIONS: In our experience high MI and in some cases SMA expression can be considered assessed risk factors. On the other hand, criteria of benign behavior did not completely predict the long-term clinical outcome.

[Krukenberg tumour: diagnostic findings and surgical therapy. Recent acquisitions]. / Tumore di Krukenberg: riscontro diagnostico e terapia chirurgica. Recenti acquisizioni.

The authors report on their experience with two cases of Krukenberg's tumour treated at Chioggia Hospital in patients admitted for pelvic tumours. The clinical manifestation of Krukenberg's tumour is mainly related to the presence of the pelvic mass even in advanced forms of gastrointestinal cancers. The authors stress the importance of an adequate follow-up of premenopausal patients with a previous gastrectomy for adenocarcinoma because the incidence of ovarian metastases is quite frequent and influences the prognosis. The Authors do not consider a bilateral preventive ovariectomy associated with gastrectomy as advisable in premenopausal patients, because the studies to date are inadequate for the purposes of drawing conclusions regarding the benefit of these procedures. They consider a more valid policy to be a thorough follow-up in women with a previous gastrectomy for adenocarcinoma because the priority must be accorded to diagnosing secondary lesions so as to be able to perform an ovariectomy which may improve the prognosis. With this in mind it is important to assess Ca 19.9 and perform radiological procedures, such as CT and MRI. The prognosis may be distinctly unfavourable as in one of the cases reported by the Authors involving a very rare form of secondary lesion of the bone marrow and consequent medullary aplasia, with the onset of severe haemorrhages in several areas leading to the patient's death. They consider that surgical treatment should be preceded by a diagnostic laparoscopy. When there are other concomitant negative prognostic factors such as neoplastic ascites and perineal carcinosis, ovariectomy will prove ineffective from the prognostic point of view.