Gastric GISTs. Personal experience.

BACKGROUND: With term GIST is now defined a group of mesenchimal tumours of the gastrointestinal tract expressing immunopositivity for kit protein kinase (CD117). Surgical therapy remains the gold standard for these rare tumours. Imatinib Mesylate (STI-571) is a potent inhibitor of Kit Kinase activity and different reports demonstrated its efficacy in unresectable or metastatic Gists. AIM OF THE PAPER: To value the incidence of GISTs among gastric mesenchimal neoplasms and analyzed their clinical presentation, prognostic parameters and surgical treatment. The response to Imatinib Mesylate in a case of metastatic GIST is then valued. METHODS: Twelve cases of gastric mesenchimal neoplasms are retrospectively reviewed and tested by CD117 immmunopositivity identifyng 8 GISTs. The median follow-up was 37 (range7-120) months. We describe in details the case of a metastatic Gist treated for 15 months with Imatinib Mesylate. RESULTS: The 67 per cent of mesenchimal gastric tumours were CD117+. Gastrointestinal bleeding was the most common presenting symptom. The 50% of patiens with malignant GISTS had a palpable abdominal mass at diagnosis. All tumors < 5 cm in diameter had a mitotic count (MC) <5/50 high-power fields (HPFs) except a case of high grade leiomyosarcoma. Surgical therapy was complete tumour resection with free margins. No recurrence was observed in lesions <5cm and < 5 mitosis/50 High Power Fields (HPFs). A good response to Imatinib Mesylate was reported in a metastatic GIST. CONCLUSION: The surgeon's role in gastric Gist's treatment is to achieve a complete cancer resection with free margins. In advanced lesions, even in presence of hepatic metastases, surgical resection of the mass is indicated because is possible to obtain a stabilization or a partial remission with Imatinib Mesylate palliative treatment in some patients.

[The sentinel lymph node biopsy. Evolution and convalidation of the technique]. / La biopsia del linfonodo sentinella. Evoluzione e convalidazione della tecnica.

BACKGROUND: Sentinel node biopsy is a minimally invasive technique alternative to routine axillary dissection in breast cancer staging. This technique selects women with positive nodes who may benefit from axillary dissection, avoiding unnecessary operations in negative node biopsies. AIMS: In this article we report a 5 year multi disciplinary experience in sentinel node biopsy involving the General Surgery Unit of Imola Hospital in collaboration with Radiologist, Pathologists and Specialists in Nuclear Medicine. METHODS: From 2000 to 2004 the Authors treated 209 women performing 214 sentinel node biopsies (in 5 cases the tumor was bilateral). Sentinel node identification was undertaken by lymphoscintigraphy; in 15 cases we associated intradermal injection of blue dye. Lymph nodes were examined by at least 60 hematoxylin and eosin stained sections and when nodes found negative were further studied with immunohistochemical stains for cytokeratins. RESULTS: Sentinel node identification rate was 99.1%. In 62 patients sentinel node was metastatic and in 17 such nodes micrometastases were detected. In 6 cases with single metastatic cells, axillary dissection was not perfomed, in accordance to current opinions. In 50 of 62 women with metastatic axillary nodes (80.6%) the sentinel node was the only metastatic one. Number of axillary dissections decreased of more than 70% in four years, from theoretical 214 to 62. CONCLUSION: Sentinel node biopsy is currently a validated technique and many breast cancer patients are spared a regional lymph node dissection without compromising local control and the accuracy of staging.