Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. There have been many risk stratification classifications systems which are calculated based on tumor size, mitotic rate, location, and perforation. The approaches to treating GISTs are to resect primary low-risk tumors, resect high-risk primary or metastatic tumors with imatinib 400 mg daily for 12 months, or if the tumor is unresectable, neoadjuvant imatinib 400 mg daily followed by surgical resection is recommended. Sunitinib is required for KIT exon 9, 13, and 14 mutations, while ponatinib is used for exon 17 mutations and regorafenib for highly refractory tumors. High-risk tumors should be monitored for recurrence with serial abdominal CT scans. Radiofrequency ablation has shown to be effective when surgery is not suitable. Newer therapies of ipilimumab, nivolumab, and endoscopic ultrasound alcohol ablation have shown promising results. This report addresses the epidemiology, clinical presentation, diagnostic imaging, histologic diagnosis, classification and risk stratification, staging and grading, surgical treatment, adjuvant treatment, and metastasis of GISTs.

/pdf/gastrointestinal-stromal-tumors-a-comprehensive-review-59jewifayd.pdf

Gastrointestinal stromal tumors: a comprehensive review.

Background The advent of tyrosine kinase inhibitors as adjuvant therapy has revolutionized the management of GIST and emphasized the need for accurate prognostication systems. Numerous prognostication systems have been proposed for GIST but at present it remains unknown which system is superior. The present systematic review aims to summarize current prognostication systems for primary treatment-naive GIST. Methods A literature review of the Pubmed and Embase databases was performed to identify all published articles in English, from the 1st January 2002 to 28th Feb 2017, reporting on clinical prognostication systems of GIST. Results Twenty-three articles on GIST prognostication systems were included. These systems were classified as categorical systems, which stratify patients into risk groups, or continuous systems, which provide an individualized form of risk assessment. There were 16 categorical systems in total. There were 4 modifications of the National Institute of Health (NIH) system, 2 modifications of Armed Forces Institute of Pathology (AFIP) criteria and 3 modifications of Joensuu (modified NIH) criteria. Of the 7 continuous systems, there were 3 prognostic nomograms, 3 mathematical models and 1 prognostic heat/contour maps. Tumor size, location and mitotic count remain the main variables used in these systems. Conclusion Numerous prognostication systems have been proposed for the risk stratification of GISTs. The most widely used systems today are the NIH, Joensuu modified NIH, AFIP and the Memorial Sloan Kettering Cancer Center nomogram. More validation and comparison studies are required to determine the optimal prognostication system for GIST.

Systematic review of current prognostication systems for primary gastrointestinal stromal tumors.

https://link.springer.com/content/pdf/10.1007/s11605-018-04070-3.pdf

Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs)

OBJECTIVE: To evaluate the applicability of the main categories of risk and morphological factors in the prognosis of gastrointestinal stromal tumors. METHODS: we retrospectively studied fifty-four cases of GIST, assessing the main prognostic factors of this neoplasis: risk levels, topography, size, mitotic index, necrosis, histological subtype and immunophenotype. We also verified their association and the reduction of overall survival. RESULTS: Univariate analysis showed that tumors with mitoses number greater than 5 per 50CGA (high-power fields), the presence of necrosis and a high risk for both the systems proposed by Fletcher and Miettinen had a significant association with reduced survival (p = 0.00001, 0.0056, 0.03 and 0.009, respectively). The remaining analyzed factors (size, histological subtype, topography and immunophenotype) had no such association. Multivariate analysis (Jacard index) showed that the Miettinen degree of risk was the one that best correlated with prognosis. CONCLUSION: the risk criteria of Fletcher and Miettinen are important in assessing the prognosis of patients with gastrointestinal stromal tumors, especially the latter, which adds to the mitotic index and the presence of tumor necrosis.

/pdf/comparative-study-of-the-different-degrees-of-risk-of-1jeoy9zcmy.pdf

Comparative study of the different degrees of risk of gastrointestinal stromal tumor

Background To determine whether preoperative computed tomography (CT) features can be used for the prediction of gastrointestinal stromal tumors (GISTs) with a high Ki-67 proliferation index (Ki-67 PI). Methods A total of 198 patients with surgically and pathologically proven GISTs were retrospectively included. All GISTs were divided into a low Ki-67 PI group ( 0.7, P<0.05). HYOM was the strongest predictive feature for the high Ki-67 PI GISTs group, with an odds ratio (OR) value of 30.037 (95% CI: 5.707-158.106). Conclusions Imaging features, including the presence of necrosis, high necrosis degree, thick wall of necrosis, and HYOM were significant predictive indicators for the high Ki-67 PI GISTs group.

/pdf/preoperative-prediction-of-gastrointestinal-stromal-tumors-4qujaocjp7.pdf

Preoperative prediction of gastrointestinal stromal tumors with high Ki-67 proliferation index based on CT features

Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors.

胰的膀胱的瘤说明 10% ～ 15% 所有膀胱的胰腺的损害。胰的膀胱的损害的多数(85% ～ 90%) 是胰的膀胱的瘤是的 pseudocysts.Although 稀罕，他们从对恶意的瘤良性。临床的挑战是膀胱的瘤的微分诊断和管理，它代表 10% ～ 25% 主要的胰腺的瘤。象有膀胱的特征的损害一样的胰腺的瘤和瘤最近被考察了。报导的胰腺的膀胱的瘤的发生是可变的。因为从把胰的膀胱的瘤的发生和生物学比作西方的系列的中国的 tne 案例上没有大、系统的学习，我们在 6 年从中山医院考察了膀胱的瘤的所有案例。大多数在我们的系列的瘤根据最近的世界健康组织被分类() 分类。粘蛋白是广泛地在上皮的房间被表示的一组高相对的分子的集体 glycoproteins。上皮的房间的恶意的转变通常与粘蛋白的反常 glycosylation 被联系。在现在的学习，我们在胰的膀胱的瘤检验了很好描绘的粘蛋白(MUC1， MUC2， MUC4， MUC5AC，和 MUC6 ) 的表示。目标是识别粘蛋白侧面，它是在胰腺的膀胱的瘤的微分诊断的一个特定的标记。

Mucins in the diagnosis and differential diagnosis of pancreatic cystic neoplasms: report of 40 cases.

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Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors.

Mucins in the diagnosis and differential diagnosis of pancreatic cystic neoplasms: report of 40 cases.