Recent Modalities in Management of Gastrointestinal Stromal Tumors
Omar Ahmed Mahmoud Mohamed;
Abstract
Gastrointestinal stromal tumours(GISTs)represent the most common mesenchymal neoplasms of the GIT. With an annual incidence of 11-14 per 106, they form 0.1%-3.0% of gastrointestinal malignant tumors (Kim et al., 2005).
GIST occurring in the familial form is autosomal dominant.(Goettschet al., 2005). Stromal tumors were referred to as smooth muscle neoplasms of GIT but immunohistochemistry (IHC) demostrated that these tumors lacked features of smooth muscle differentiation and, while some had markers of neuronal differentiation, some had neither.(Joensuu et al., 2006).
Only 70% of the patients with GIST are symptomatic, while 20% are asymptomatic and the tumors are detected incidentally, 10% of the lesions are detected only at autopsy. Symptoms and signs are not disease specific, they are related more to the site of the tumor. Bleeding (30%-40%) comprises the most common symptom after vague abdominal discomfort (60%-70%). Bleeding is attributed to the erosion into the GIT lumen. Bleeding occurring into the peritoneal cavity due to a ruptured GIST can lead to acute abdominal pain presenting as a surgical emergency. Bleeding into the GI tract lumen, causing hematemesis, melena or anemia, is usually more chronic on presentation. Most of the patients present with vague symptoms, such as nausea, vomiting, abdominal discomfort, weight loss or early satiety. Symptoms are usually site specific, these include dysphagia in the esophagus, biliary obstruction around The ampulla of Vater or even intussusception of the small bowel (Goettsch et al., 2005).
GIST usually has an exophytic growth and the common intra-operative appearance is that of a mass attached to the stomach, projecting into the abdominal cavity and displacing other organs. Mucosal ulceration may be present at the summit of the lesion in 50% of cases. On gross appearance they are smooth gray and white tumors which are well circumscribed, usually with a pseudocapsule. A small area of hemorrhage or cystic degeneration and necrosis may be visible (Beham et al., 2012).
Due to the vague presentation of GIST, initial diagnosis can be delayed. Imaging in the form of contrast enhanced computed tomography (CECT) is the modality of choice; it is used to characterize the lesion, evaluate its extent, and assess the presence or absence of metastasis at the initial staging workup. CECT is also used for monitoring response to therapy and performing follow-up surveillance of recurrence (Stamatakos et al., 2009).
GIST occurring in the familial form is autosomal dominant.(Goettschet al., 2005). Stromal tumors were referred to as smooth muscle neoplasms of GIT but immunohistochemistry (IHC) demostrated that these tumors lacked features of smooth muscle differentiation and, while some had markers of neuronal differentiation, some had neither.(Joensuu et al., 2006).
Only 70% of the patients with GIST are symptomatic, while 20% are asymptomatic and the tumors are detected incidentally, 10% of the lesions are detected only at autopsy. Symptoms and signs are not disease specific, they are related more to the site of the tumor. Bleeding (30%-40%) comprises the most common symptom after vague abdominal discomfort (60%-70%). Bleeding is attributed to the erosion into the GIT lumen. Bleeding occurring into the peritoneal cavity due to a ruptured GIST can lead to acute abdominal pain presenting as a surgical emergency. Bleeding into the GI tract lumen, causing hematemesis, melena or anemia, is usually more chronic on presentation. Most of the patients present with vague symptoms, such as nausea, vomiting, abdominal discomfort, weight loss or early satiety. Symptoms are usually site specific, these include dysphagia in the esophagus, biliary obstruction around The ampulla of Vater or even intussusception of the small bowel (Goettsch et al., 2005).
GIST usually has an exophytic growth and the common intra-operative appearance is that of a mass attached to the stomach, projecting into the abdominal cavity and displacing other organs. Mucosal ulceration may be present at the summit of the lesion in 50% of cases. On gross appearance they are smooth gray and white tumors which are well circumscribed, usually with a pseudocapsule. A small area of hemorrhage or cystic degeneration and necrosis may be visible (Beham et al., 2012).
Due to the vague presentation of GIST, initial diagnosis can be delayed. Imaging in the form of contrast enhanced computed tomography (CECT) is the modality of choice; it is used to characterize the lesion, evaluate its extent, and assess the presence or absence of metastasis at the initial staging workup. CECT is also used for monitoring response to therapy and performing follow-up surveillance of recurrence (Stamatakos et al., 2009).
Other data
| Title | Recent Modalities in Management of Gastrointestinal Stromal Tumors | Other Titles | الوسائل الحديثة فى تشخيص و علاج الأورام السديه بالجهاز الهضمى | Authors | Omar Ahmed Mahmoud Mohamed | Issue Date | 2016 |
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