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1.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504522

RESUMO

We report the case of an 84-year-old male patient suffering from a gastrointestinal stromal tumour (GIST) of the rectum who was referred to our ENT (Ear-Nose-Throat) clinic for a rapidly progressive stridor, aphagia and dysphonia. The clinical examination revealed a mass arising from the posterior wall of the pharynx, which obstructed the laryngeal inlet and thus the airway. A metastasis of the GIST was suspected. After completing the investigation with radiological imaging, the patient underwent surgery, which consisted of a tracheostomy to secure the airway and a biopsy of the mass. The pathological examination confirmed the suspected diagnosis of a GIST vertebral metastasis.


Assuntos
Vértebras Cervicais , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Idoso de 80 Anos ou mais , Biópsia , Transtornos de Deglutição/etiologia , Progressão da Doença , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/secundário , Humanos , Masculino , Sons Respiratórios/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Traqueostomia
2.
Nihon Shokakibyo Gakkai Zasshi ; 117(10): 888-895, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33041300

RESUMO

In order to demonstrate the bleeding risk factors of GIST (gastrointestinal stromal tumor), we retrospectively investigated clinicopathological features between hemorrhagic (H group, 24 cases) and nonhemorrhagic GIST (NH group, 30 cases). In addition, we investigated features between the E group (6 cases) necessitating TAE (trans-catheter arterial embolization) and NE group (other 48 cases). Whereas H group partly includes high-risk grade GIST with chronic bleeding, meanwhile the E group (reflecting acute bleeding) is characterized by a highly enhanced mass with ulceration, comprising of smaller low-risk grade GIST. Amongst the 29 cases for forceps biopsy, which were 6 cases (21%) including one of E group, needed be hospitalized for postbiopsy bleeding. Acute bleeding in GIST may not be associated with malignant transformation. Postbiopsy bleeding or massive hemorrhage can also be encountered particularly in highly enhanced GIST with ulceration, even with a small and low-risk grade.


Assuntos
Embolização Terapêutica , Tumores do Estroma Gastrointestinal , Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/terapia , Humanos , Estudos Retrospectivos
3.
Nihon Shokakibyo Gakkai Zasshi ; 117(10): 914-918, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33041303

RESUMO

A fifty-year-old man with a liver metastasis of a duodenal gastrointestinal stromal tumor (GIST) previously treated with imatinib. Thirty-three months following initiation of the therapy, he visited the emergency room of our hospital presenting with an upper abdominal pain. Dynamic CT scan revealed a ruptured liver metastasis of duodenal GIST. We used transcatheter arterial embolization to stop the bleeding. Due to the rarity of this condition, we herein report this case with an article review.


Assuntos
Embolização Terapêutica , Tumores do Estroma Gastrointestinal , Neoplasias Hepáticas , Duodeno , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Mesilato de Imatinib/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
4.
Asia Pac J Clin Oncol ; 16(5): e207-e215, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32762133

RESUMO

AIM: The metabolic behavior and the prognostic value of 18 F-FDG-PET/CT in gastrointestinal stromal tumor (GIST) is not well investigated. The aim of this study was to analyze the metabolic behavior of GIST and the prognostic role of pretreatment PET/CT features. METHODS: In this retrospective study, we included 35 patients with a diagnosis of GIST who underwent a pretreatment 18 F-FDG-PET/CT scan. We analyzed PET images visually and semiquantitatively by measuring several metabolic parameters as the maximum standardized uptake value corrected for body weight (SUVbw), for lean body mass (SUVlbm), for body surface area (SUVbsa), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The Kaplan-Meier method was used to measure the progression free survival (PFS) and overall survival curves. RESULTS: Twenty-nine (82%) patients showed a positive 18 F-FDG-PET/CT, whereas the remaining 6 had no hypermetabolic lesions. 18 F-FDG-avidity was significantly related with mitotic index, tumor stage and tumor risk group. Instead, semiquantitative PET/CT parameters correlated only with tumor risk group. Disease progression occurred in 16 patients whereas death in seven. 18 F-FDG-avidity, MTV and TLG were the only variables significantly associated with PFS. CONCLUSION: An 82% rate of PET avidity in GIST was found and it was correlated with stage, tumor risk group and mitotic index. Only baseline 18 F-FDG-avidity, MTV and TLG were independently correlated with PFS.


Assuntos
Fluordesoxiglucose F18/uso terapêutico , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(16): e19885, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312014

RESUMO

RATIONALE: Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor. PATIENT CONCERNS: A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings. DIAGNOSIS: Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(-), Dog-1(+), Ki-67% <1%, and smooth muscle actin(-). INTERVENTIONS: Surgical resection was performed on the patient. OUTCOMES: The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis. LESSONS: In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/patologia , Estômago/patologia , Assistência ao Convalescente , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/metabolismo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Clin Nucl Med ; 45(5): 372-373, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32149788

RESUMO

A 17-year-old boy presented with fatigue, hypoxia, palpitations, and anemia (hemoglobin 3.5 g/dL). The search for the etiology of the bleeding began with a Meckel scan. A photopenic region in the gastric body and a region of abnormal tracer uptake in the right midabdomen were unexpected findings. Further investigation with ultrasound and computed tomography revealed a gastric mass, which proved to be a gastrointestinal stromal tumor at pathology. The right-sided tracer uptake resulted from stasis in the collecting system of a malpositioned right kidney, a cause of false uptake in a Meckel scan.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Achados Incidentais , Divertículo Ileal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Gástricas/diagnóstico por imagem , Adolescente , Tumores do Estroma Gastrointestinal/complicações , Humanos , Masculino , Divertículo Ileal/complicações , Neoplasias Gástricas/complicações
8.
Medicine (Baltimore) ; 99(9): e19275, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118738

RESUMO

The advent of imatinib mesylate (IM) has dramatically revolutionized the prognosis of advanced and metastatic/recurrent gastrointestinal stromal tumors (GISTs). The objective of this retrospective study is to investigate the safety and efficacy of combination of surgery following IM treatment in the management of advanced and metastatic/recurrent GISTs. We further explore the long-term clinical outcomes in these who underwent therapy of preoperative IM.Eligible patients with GISTs before the onset of the IM therapy and were periodically followed up in the outpatient clinic were included in this study. Detailed clinical and pathologic characteristics were obtained from the medical records of our institution. Univariate and multivariate regression analyses were performed to use for the evaluation of potential prognostic factors.A total of 51 patients were included in the study, of these patients, 36 patients underwent surgery and median duration of preoperative IM is 8.2months (range 3.5-85 months). Significant median tumor shrinkage rate was 29.27% (95% confidence interval 21.00%-34.00%) observed in these patients who responded to IM, and partial response and stable disease were achieved in 24 patients (47.06%) and 23 patients (45.10%), respectively, in light of the RECIST guideline (version 1.1). After the median follow-up of 43.70 months (range 14.2-131.1 months), 1- and 3-year overall survival (OS) were estimated to be 96.1% and 94.0%, respectively, and there was a significant improvement in OS for patients who received surgical intervention versus those who did not.Our study consolidates that patients were received preoperative IM therapy could shrink the size of tumors and facilitate organ-function preservation. The long-term analysis on this study supports that surgical intervention following IM therapy benefits for patients with primary advanced and recurrent or metastatic GISTs on long-term prognosis.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/terapia , Mesilato de Imatinib/uso terapêutico , Recidiva Local de Neoplasia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , China , Feminino , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/patologia , Humanos , Mesilato de Imatinib/administração & dosagem , Masculino , Registros Médicos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
9.
BMJ Case Rep ; 13(2)2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32033995

RESUMO

Gastrointestinal stromal tumour (GIST) is a recent recognised tumour entity. In the past, those tumours were classified as leiomyomas, leiomyosarcomas and leiomyoblastomas, but it is now evident that GIST is a separate tumour entity and is the most common sarcoma of the gastrointestinal tract especially with advances in immunohistochemical staining techniques and improvements in microscopic structural imaging. We present a case of GIST of unusual location and presentation pattern, with an overview over current GISTs' diagnosis and management strategies. The precise incidence and tumour behaviour of rare extragastrointestinal stromal tumour (EGIST) remain to be clarified. Further research is needed in large series with long duration of follow-up and modified risk stratification assessment tailored for EGISTs.


Assuntos
Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Idoso , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Laparotomia , Imagem por Ressonância Magnética , Masculino , Neoplasias de Tecidos Moles/diagnóstico por imagem , Ultrassonografia
10.
Ann Palliat Med ; 9(1): 98-107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32005068

RESUMO

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract. Small intestine is the second most popular location of GIST, named small intestinal stromal tumor (SIST). The cumulative incidence of malignancy of SIST is twice that of gastric GIST. However, research studies on SIST are relatively rare. METHODS: The present retrospective study included 75 patients with SIST who underwent surgery resection and postoperative pathological diagnosis and analyzed the clinical manifestations, histopathological and immunohistochemical features, advantages and disadvantages of various auxiliary examinations, the treatment and prognosis of SIST. RESULTS: The number of Patients who had gastrointestinal bleeding was significantly higher than patients who had abdominal mass. Cases in the jejunum was significantly more than that in duodenum and ileum groups. With the increase of tumor diameter, the invasion risk also gradually increased. Patients with adverse outcome had bigger tumor diameter than patients with favorable outcome. For patients with adverse outcome, the nuclear division >5/50 HPF constitution is significantly higher than patients with favorable outcome. When categorized into 3 cell types according to cell morphology, the spindle-epithelioid cell type appeared only in patients with adverse outcome. Cox regression analysis indicated that tumor diameter 5.3 cm or higher and nuclear division > 5/50 can be independent risk factors for predicting SIST postoperative adverse outcome. CONCLUSIONS: The present study analyzed the clinical statistics of SIST patients and improved the understanding of this disease and provided valid statistics for clinical diagnosis and treatment.


Assuntos
Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Intestino Delgado/patologia , Adulto , Estudos de Casos e Controles , Feminino , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Diagn Pathol ; 15(1): 8, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005261

RESUMO

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common type of adult mesenchymal neoplasms. The events that drive GIST oncogenesis are primarily KIT or PDGFRA mutations, which lead to the susceptibility of these tumors to small-molecule tyrosine kinase inhibitors such as imatinib and sunitinib. However, previous studies have shown that patients with a PDGFRA D842V mutation in GISTs have a very low rate of response to imatinib treatment. Therefore, novel tyrosine kinase inhibitors (TKIs) are currently being evaluated in clinical trials to treat GISTs harboring a PDGFRA D842V mutation. Anaplastic lymphoma kinase (ALK) overexpression was not expected to be present in the GIST, and it has been used as a biomarker to distinguish GISTs from other types of mesenchymal tumors. CASE PRESENTATION: Here, we report a 37-year-old male patient who presented with a large mass in the right upper abdomen and was subsequently diagnosed with a GIST harboring a PDGFRA D842V mutation. We unexpectedly found that the GIST in this patient exhibited simultaneous ALK expression. CONCLUSIONS: This is the first case reported of a GIST with ALK expression. This rare phenomenon suggests that the diagnosis of a GIST cannot be excluded absolutely if a tumor exhibits ALK expression. In addition, ALK may be a potential therapeutic target for patients with imatinib-resistant stromal tumors.


Assuntos
Antineoplásicos/uso terapêutico , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Adulto , Substituição de Aminoácidos , Tumores do Estroma Gastrointestinal/genética , Tumores do Estroma Gastrointestinal/patologia , Humanos , Mesilato de Imatinib/uso terapêutico , Masculino , Mutação , Piperazinas/uso terapêutico
12.
Radiol Med ; 125(5): 465-473, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32048155

RESUMO

PURPOSE: The pathological risk degree of gastrointestinal stromal tumors (GISTs) has become an issue of great concern. Computed tomography (CT) is beneficial for showing adjacent tissues in detail and determining metastasis or recurrence of GISTs, but its function is still limited. Radiomics has recently shown a great potential in aiding clinical decision-making. The purpose of our study is to develop and validate CT-based radiomics models for GIST risk stratification. METHODS: Three hundred and sixty-six patients clinically suspected of primary GISTs from January 2013 to February 2018 were retrospectively enrolled, among which data from 140 patients were eventually analyzed after exclusion. Data from patient CT images were partitioned based on the National Institutes of Health Consensus Classification, including tumor segmentation, radiomics feature extraction and selection. A radiomics model was then proposed and validated. RESULTS: The radiomics signature demonstrated discriminative performance for advanced and nonadvanced GISTs with an area under the curve (AUC) of 0.935 [95% confidence interval (CI) 0.870-1.000] and an accuracy of 90.2% for validation cohort. The radiomics signature demonstrated favorable performance for the risk stratification of GISTs with an AUC of 0.809 (95% CI 0.777-0.841) and an accuracy of 67.5% for the validation cohort. Radiomics analysis could capture features of the four risk categories of GISTs. Meanwhile, this CT-based radiomics signature showed good diagnostic accuracy to distinguish between nonadvanced and advanced GISTs, as well as the four risk stratifications of GISTs. CONCLUSION: Our findings highlight the potential of a quantitative radiomics analysis as a complementary tool to achieve an accurate diagnosis for GISTs.


Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Intervalos de Confiança , Feminino , Tumores do Estroma Gastrointestinal/patologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Estudos Retrospectivos , Medição de Risco/métodos , Carga Tumoral
13.
Cancer Imaging ; 20(1): 5, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931874

RESUMO

BACKGROUND: Gastrointestinal stromal tumors (GISTs), which are the most common mesenchymal tumors of the digestive system, are treated varyingly according to the malignancy. The purpose of this study is to develop and validate a nomogram for preoperative prediction of the malignant potential in patients with GIST. METHODS: A total of 440 patients with pathologically confirmed GIST after surgery in our hospital from January 2011 to July 2019 were retrospectively analyzed. They were randomly divided into the training set (n = 308) and validation set (n = 132). CT signs and texture features of each patient were analyzed and predictive model were developed using the least absolute shrinkage and selection operator (lasso) regression. Then a nomogram based on selected parameters was developed. The predictive effectiveness of nomogram was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). Concordance index (C-index) and calibration plots were formulated to evaluate the reliability and accuracy of the nomogram by bootstrapping based on internal (training set) and external (validation set) validity. The clinical application value of the nomogram was determined through the decision curve analysis (DCA). RESULTS: Totally 156 GIST patients with low-malignant (very low and low risk) and 284 ones with high-malignant potential (intermediate and high risk) are enrolled in this study. The prediction nomogram consisting of size, cystoid variation and meanValue had an excellent discrimination both in training and validation sets (AUCs (95% confidence interval(CI)): 0.935 (0.908, 0.961), 0.933 (0.892, 0.974); C-indices (95% CI): 0.941 (0.912, 0.956), 0.935 (0.901, 0.982); sensitivity: 81.4, 90.6%; specificity: 75.0, 75.7%; accuracy: 88.0, 88.6%, respectively). The calibration curves indicated a good consistency between the actual observation and nomogram prediction for differentiating GIST malignancy. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION: This study presents a prediction nomogram that incorporates the CT signs and texture parameter, which can be conveniently used to facilitate the preoperative individualized prediction of malignancy in GIST patients.


Assuntos
Neoplasias Gastrointestinais/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Imageamento Tridimensional/métodos , Nomogramas , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Imageamento Tridimensional/normas , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/normas
14.
Eur Radiol ; 30(4): 1856-1865, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900704

RESUMO

BACKGROUND: Tumor shape is strongly associated with some tumor's genomic subtypes and patient outcomes. Our purpose is to find the relationship between risk stratification and the shape of GISTs. METHODS: A total of 101 patients with primary GISTs were confirmed by pathology and immunohistochemistry and underwent enhanced CT examination. All lesions' pathologic sizes were 1 to 10 cm. Points A and B were the extremities of the longest diameter (LD) of the tumor and points C and D the extremities of the small axis, which was the longest diameter perpendicular to AB. The four angles of the quadrangle ABCD were measured and each angle named by its summit (A, B, C, D). For regular lesions, we took angles A and B as big angle (BiA) and small angle (SmA). For irregular lesions, we compared A/B ratio and D/C ratio and selected the larger ratio for analysis. The chi-square test, t test, ROC analysis, and hierarchical or binary logistic regression analysis were used to analyze the data. RESULTS: The BiA/SmA ratio was an independent predictor for risk level of GISTs (p = 0.019). With threshold of BiA at 90.5°, BiA/SmA ratio at 1.35 and LD at 6.15 cm, the sensitivities for high-risk GISTs were 82.4%, 85.3%, and 83.8%, respectively; the specificities were 87.1%, 71%, and 77.4%, respectively; and the AUCs were 0.852, 0.818, and 0.844, respectively. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could (p < 0.05). Shape and Ki-67 were independent predictors of the mitotic value (p = 0.036 and p < 0.001, respectively), and the accuracy was 87.8%. CONCLUSIONS: Quantifying tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs, especially for high-risk grading and mitotic value > 5/50HPF. KEY POINTS: • The BiA/SmA ratio was an independent predictor affecting the risk level of GISTs. LD could not effectively distinguish between intermediate-risk and high-risk GISTs, but BiA could. • Shape and Ki-67 were independent predictors of the mitotic value. • The method for quantifying the tumor shape has better predictive efficacy than LD in predicting the risk level and mitotic value of GISTs.


Assuntos
Neoplasias Gastrointestinais/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Neoplasias Gastrointestinais/metabolismo , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/metabolismo , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Prognóstico , Curva ROC , Medição de Risco , Carga Tumoral
16.
Ann R Coll Surg Engl ; 102(2): e29-e32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31508985

RESUMO

Although the optimal surgical procedure for the resection of duodenal gastrointestinal stromal tumours has not yet been characterised due to the low prevalence of these tumours and the anatomical complexity of the duodenopancreatic region, difficult surgical procedures such as pancreaticoduodenectomy are often proposed for stromal tumours located in the second portion of the duodenum. Our case report highlights a novel surgical strategy that can be implemented as an alternative to pancreaticoduodenectomy for such tumours close to the duodenal ampulla. A 70-year-old man incidentally diagnosed with a stromal tumour close to the duodenal ampulla in the second portion of the duodenum underwent local resection guided by an endoscopic nasobiliary drainage tube with primary closure. This tube was converted to a percutaneous trans-small intestinal biliary drainage tube during the procedure to prevent biliary leakage biliary stasis due to swelling of the duodenal ampulla. He also underwent a simple distal gastrectomy with Roux-en-Y reconstruction. This resulted in successful R0 resection. There were no procedure-related complications or post-surgery weight changes. Our simple novel surgical strategy may therefore be useful for avoiding pancreaticoduodenectomy and maintaining quality of life in patients with stromal tumours close to the duodenal ampulla.


Assuntos
Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Idoso , Ampola Hepatopancreática , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Endoscopia do Sistema Digestório , Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
17.
Gastrointest Endosc ; 91(1): 172-177.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539527

RESUMO

BACKGROUND AND AIMS: EUS elastography is a real-time imaging technique that analyzes tissue elasticity. The aim of this study was to investigate the applicability of quantitative EUS elastography in the differential diagnosis of gastric subepithelial tumors (SETs). METHODS: We prospectively registered 41 consecutive patients with gastric SETs and measured their strain ratios with EUS elastography. The strain ratios of gastric SETs were compared with the histopathologic diagnosis. RESULTS: Thirty-one patients (mean age, 51.4 ± 12.6 years) were included in the analysis. The mean size of the SETs was 2.3 ± 0.7 cm. Lipomas had the lowest strain ratio of 1.6 (1.1-2.0), followed by leiomyomas 6.0 (2.0-29.0), ectopic pancreas 11.8 (1.7-29.3), gastrointestinal stromal tumors (GISTs) 51.1 (29.0-67.0), and schwannomas 62.0. With a cut-off value of 22.7, EUS elastography could differentiate GISTs from leiomyomas with sensitivity and specificity of 100% and 94.1%, respectively (P = .001; 95% confidence interval, 0.979-1.000). CONCLUSIONS: EUS elastography could be a promising diagnostic adjunct for the assessment of gastric SETs, especially in differentiating GISTs from leiomyomas.


Assuntos
Técnicas de Imagem por Elasticidade , Endossonografia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Adulto , Idoso , Coristoma/diagnóstico , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Leiomioma/diagnóstico , Lipoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Pâncreas , Projetos Piloto , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico
19.
Dig Dis Sci ; 65(2): 583-590, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31410755

RESUMO

BACKGROUND: In cases of subepithelial tumors (SETs) located in the cardiac area, a preoperative histologic diagnosis might be helpful in determining the requirement of surgery. AIM: To investigate the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) in gastric SETs located in the cardia. METHODS: The data of 107 patients who underwent EUS-FNB, from 2012 to 2017, for tissue sampling of gastric SETs located in the cardia were collected. The clinicopathological data, EUS-related parameters, and surgical outcomes were retrospectively reviewed. RESULTS: The EUS-FNB results were diagnostic in 86.9% (93/107) and nondiagnostic in 13.1% (14/107) of the patients. Immunostaining of the FNB specimens led to the diagnosis of gastrointestinal stromal tumor (GIST) in 25 SETs (23.4%), leiomyoma in 62 SETs (57.9%), heterotopic pancreas in 3 SETs (2.8%), and schwannoma in 2 SETs (1.9%). In the multivariate analysis, patients with GISTs showed significantly more inhomogeneous echogenicity [odds ratio (OR), 8.867], more cystic foci (OR, 26.98), and older age (OR, 1.087). In 26 patients who underwent surgical resection, the agreement between EUS-FNB and surgical pathological findings was 100% with respect to the diagnosis of GISTs (n = 20) and leiomyoma (n = 7). Among these cases, the proportion of high-risk GISTs was 20.0% (4/20), and no leiomyosarcoma was detected. CONCLUSIONS: Although a majority of the subepithelial lesions in the cardia of the stomach are benign, 20% of the cases diagnosed with GIST have a high malignant potential. Preoperative EUS-FNB might be a useful tool for decision-making regarding the ultimate management and outcomes of these lesions.


Assuntos
Cárdia/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Tumores do Estroma Gastrointestinal/patologia , Leiomioma/patologia , Neoplasias Gástricas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cárdia/diagnóstico por imagem , Cárdia/cirurgia , Coristoma/diagnóstico , Coristoma/patologia , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/patologia , Pâncreas , Estudos Retrospectivos , Gastropatias/diagnóstico , Gastropatias/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Adulto Jovem
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