Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors Jianjun Yang†, Fan Feng†, Mengbin Li†, Li Sun, Liu Hong, Lei Cai, Wenbin Wang, Guanghui Xu and Hongwei Zhang*
Abstract Background: The National Comprehensive Cancer Network (NCCN) recommends conservative follow-up for gastric gastrointestinal stromal tumors (GISTs) less than 2 cm. The aim of the present study was to investigate the clinical and pathological features of small gastric GISTs, re-evaluate the risk potential, and discuss the treatment strategy of small gastric GISTs. Methods: In this retrospective study, 63 cases of small gastric GISTs (less than 2 cm) were resected surgically from May 2010 to March 2013 in our department. Clinicopathological factors were collected and the malignant potential of small gastric GISTs was analyzed. Results: The mitotic index of 14 out of 63 cases (22.22%) exceeded 5. The malignant potential of small gastric GISTs was related to tumor location (P = 0.0218). The mitotic index of 4 out of 8 GISTs (50%) located in gastric cardia exceeded 5, 8 out 28 GISTs (28.57%) located in the gastric fundus exceeded 5, and only 2 out of 27 GISTs (7.41%) located in the gastric body exceeded 5. We also discovered a good consistency between mitotic index and Ki-67 expression of small gastric GISTs. Conclusions: Gastric GISTs less than 2 cm also have malignant potential. Thus, we recommended surgical resection of all small gastric GISTs once diagnosed. Keywords: Gastric gastrointestinal stromal tumor, Malignant potential, Mitotic index, Gene mutation
Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract and represent 1% to 2% of all gastrointestinal malignancies [1]. They are considered to be derived from the interstitial cells of Cajal, the pacemaker cells of the gastrointestinal tract [2]. This has been established by immunohistochemical staining of GISTs for CD117, CD34, smooth muscle actin, desmin and S-100 [3]. In 1998, Hirota et al. reported that GISTs are associated with gain-of-function mutations in the KIT protooncogene [2]. Histologically, most GISTs display spindle * Correspondence: [email protected] † Equal contributors Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi, China
cell morphology (70%), whereas a minority is of epithelioid (20%) or mixed phenotypes (10%) [4]. GISTs can occur anywhere throughout the gastrointestinal tract and are seen most commonly in the stomach (40 to 70%), small intestine (20 to 40%), and colon and rectum (5 to 15%) [5]. Rare cases have been reported in the esophagus, appendix, greater omentum, and gallbladder [6]. Patients with gastric GISTs may be completely asymptomatic or present with abdominal pain, dyspepsia, anorexia, bleeding, obstruction or tarry stool [7]. According to the NCCN guideline [8]
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