Jsmc-10286

GASTROINTESTINAL STROMAL TUMORS: A CLINICOPATHOLOGIC AND RISK STRATIFICATION STUDY OF 109 CASES IN SULAYMANIYAH CITY-KURDISTAN REGION OF IRAQ

Barham M. M. Salih a

a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

Submitted: 30/5/2020; Accepted: 30/9/2020; Published: 21/3/2021

DOI Link: https://doi.org/10.17656/jsmc.10286

ABSTRACT

Background

Gastrointestinal stromal tumors (GISTs) are rare and heterogeneous tumors that occur throughout the GIT most commonly in the stomach or small intestine. They grow from specialized cells in the gastrointestinal tract called interstitial cells of Cajal (ICCs) or precursors to these cells.

Objectives

To describe GISTs cases and perform risk stratification based on both the (AFIP) classiﬁcation and TNM staging.

Materials and Methods

The data were collected retrospectively from registries and documents in Hiwa Hospital and the histopathology department in Shorsh Teaching Hospital in Sulaimaniyah between 2010 and 2019. The histopathological features extracted from the reports included the site of a tumor, size of tumor, histological type, mitotic count/50 high power fields (HPF), risk behavior assessment, and presence or absence of necrosis, and metastasis. Risk stratification was conducted by assigning the cases to specific risk categories and groups for disease progression based on Armed Forces Institute of Pathology Criteria (AFIPC) and staging according to the TNM system (AJCC 8th edition).

Results

A total of 109 cases of GIST diagnosed between 2010 and 2019 were included. More than half (52.3%) of the cases were female. The age range was 28 to 87 years with a mean age of 58 years. Most (67.9%) of GISTs occurred between 48 and 77 years of age. The mean diameter of tumors was 8.18 cm. Around half (48.6%) of the GISTs were in the stomach, 60.6% of the cases had spindle cell type morphology and 82.6% were CD117 positive. Based on AFIPC risk stratification 34.0 % of the total cases were high risk. As per the Staging criteria of the TNM system (AJCC 8th edition), 37.6% were stage I followed by stage III (28.4%), stage II (17.4%), and stage IV (16.5%).

Conclusion

Most of the patients in the current study had GIST in the stomach and were in a high-risk category. The current epidemiological and morphologic findings were similar to prevailing knowledge. However, only 82.6% were CD 117 Positive.

KEYWORDS

Gastrointestinal stromal tumor; Extra gastrointestinal tumor; AFIPC risk stratification; TNM staging.

References

1. Van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years later. Cancer 2005 Nov 1;104(9):1781–1788.

2. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics. 2003;23(2):283-304.

3. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002 May; 33 (5)459–465

4. Demetri GD. Gastrointestinal stromal tumors. In: VT DeVita, S Hellman, SA Rosenberg, editors. Cancer: principles and practice of oncology. Philadelphia, PA: Lippincott Williams & Wilkins; 2005 7th ed. P. 1050–1060.

5. Machado-Aranda D, Malamet M, Chang YJ, Jacobs MJ, Ferguson L, Silapaswan S, et al. Prevalence and management of gastrointestinal stromal tumors. Am Surg. 2009 Jan; 75(1): 55-60.

6. Kim KM, Kang DW, Moon WS, Park JB, Park CK, Sohn JH, et al. Gastrointestinal stromal tumors in Koreans: its incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci. 2005 Dec; 20(6): 977-984.

7. Goettsch WG, Bos SD, Breekveldt-Postma N, Casparie M, Herings RM, Hogendoorn PC. Incidence of gastrointestinal stromal tumors is underestimated: results of a nationwide study. Eur J Cancer. 2005 Dec; 41(18): 2868-2872.

8. Miettinen M, Lasota J. Gastrointestinal stromal tumors (GISTs): definition, occurrence, pathology, differential diagnosis, and molecular genetics. Pol J Pathol. 2003; 54(1): 3-24.

9. Miettinen M, Fletcher CDM, Kindblom LG, Tsui WMS. Mesenchymal tumors of the stomach. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. P. 74–9.

10. Patil DT, Rubin BP. Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med. 2011; 135(10):1298–310.

11. Miettinen M, Fletcher CDM, Kindblom LG, Tsui WMS. Mesenchymal tumors of the small intestine. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. P. 115–6.

12. Miettinen M, Fletcher CDM, Kindblom LG, Tsui WMS. Mesenchymal tumors of the colon and rectum. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. P. 181–2.

13. Miettinen MM, Lasota J, Corless CL, Rubin BP, Debiec-Rychter M, Sciot R, et al. Gastrointestinal stromal tumors. In: Fletcher DM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO classification of tumors of soft tissue and bone. 4th ed. Lyon: IARC; 2013. P. 164–7.

14. Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003 Jan; 299(5607): 708-710.

15. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998 Jan; 279(5350): 577-580.

16. Hirota S, Nishida T, Isozaki K, Taniguchi M, Nakamura J, Okazaki T, et al. Gain-of-function mutation at the extracellular domain of KIT in gastrointestinal stromal tumours. J Pathol. 2001 Apr; 193(4): 505-510.

17. Lux ML, Rubin BP, Biase TL, Chen CJ, Maclure T, Demetri G, et al. KIT extracellular and kinase domain mutations in

gastrointestinal stromal tumors. Am J Pathol. 2000 Mar; 156(3): 791-795.

18. Miettinen M, Lasota J. Gastrointestinal stromal tumors — deﬁnition, clinical, histological, immunohistochemical, and molecular genetics features and differential diagnosis. Virchows Arch. 2001 Jan; 438(1):1–12.

19. Pierie JP, Choudry U, Muzikansky A. The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg. 2001 Apr; 136(4):383–389

20. Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G. Clinical management of gastrointestinal stromal tumors: before and after STI-571. Hum Pathol. 2002 May; 33(5):466–477.

21. Foo WC, Liegl-Atzwanger B, Lazar AJ. Pathology of gastrointestinal stromal tumors. Clin Med Insights Pathol. 2012; 5:23–33

22. Langenberg S, Reyners AKL, Wymenga ANM, Sieling GCM, Veldhoven CMM, van Herpen CML, et al. Caregivers of patients receiving long-term treatment with a tyrosine kinase inhibitor (TKI) for gastrointestinal stromal tumor (GIST): a cross-sectional assessment of their distress and burden. Acta Oncol. 2019; 58(2):191-9.

23. Joensuu H. Risk stratiﬁcation of patients diagnosed with the gastrointestinal stromal tumor. Hum Pathol. 2008 Oct; 39(10):1411–9.

24. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006 May; 23(2):70–83

25. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC staging manual. 7th ed. New York: Springer; 2010.

26. Takahashi T, Nakajima K, Nishitani A, Souma Y, Hirota S, Sawa Y, et al. An enhanced risk-group stratiﬁcation system for more practical prognostication of clinically malignant gastrointestinal. Int J Clin Oncol. 2007 Oct;12(5):369-74

27. Joensuu H, Vehtari A, Riihima ¨ki J, Nishida T, Steigen SE, Brabec P, et al. Risk of recurrence of gastrointestinal stromal tumor after surgery: an analysis of pooled population-based cohorts. Lancet Oncol. 2012 Mar; 13(3):265–74.

28. Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumors. 7th ed: Oxford: John Wiley & Sons; 2011 Aug 31.

29. Cavaliere D, Guido G, Venturino E, Schirru A, Cosce U, Cristo L, et al. Management of patients with gastrointestinal stromal tumors: experience from an Italian group. Tumori 2005; 91(6):467–471.

30. Asija AP, Mejia AV, Prestipino A, Pillai MV. Gastrointestinal Stromal Tumors: A Review. American Journal of Therapeutics. 2016 Mar-Apr;23(2):e550-7.

31. Rossi CR, Mocellin S, Mencarelli R, Foletto M, Pilati P, Nitti D, et al. Gastrointestinal stromal tumors: from a surgical to a molecular approach. Int J Cancer. 2003 Nov1; 107(2):171–176.

32. Hatipoğlu E, Demiryas S. Gastrointestinal stromal tumors: 16 years’ experience within a university hospital. Rev Esp Enferm Dig. 2018; 110(6):358-364.

33. Jumniensuk C, Charoenpitakchai M. Gastrointestinal stromal tumor: clinicopathological characteristics and pathologic prognostic analysis. World journal of surgical oncology. 2018 Dec 1;16(1):231.

34. Abood RA, Alasady OG, Khalaf AA. Gastrointestinal stromal tumors in southern Iraq: clinico-pathologic patterns and risk stratification. American Journal of Bio Medicine. 2018; 7(2): 432-440.

35. Salari M, Ahady M, Hoseini SM, Mokhtari E, Gafarzadehgan K, Hashemian HR, et al. Gastrointestinal Stromal Tumors in Northeastern Iran: 46 Cases During 2003-2012. Middle East Journal of Digestive Diseases. 2015 Jul; 7(3):161.

36. Chen T, Ye LY, Feng XY, Qiu HB, Zhang P, Luo YX, et al. Performance of risk stratification systems for gastrointestinal stromal tumors: A multicenter study. World J Gastroenterol 2019; 25(10): 1238-1247.

37. Antonescu CR, Sommer G, Sarran L, Tschernyavsky SJ, Riedel E, Woodruff JM, et al. Association of KIT exon 9 mutations with the nongastric primary site and aggressive behavior: KIT mutation analysis and clinical correlates of 120 gastrointestinal stromal tumors. Clin Cancer Res. 2003; 9(9):3329–37.

38. Bhalgami R, Manish K, Patil P, Mehta S, Mohandas KM. Clinicopathological study of 113 gastrointestinal stromal tumors. Indian J Gastroenterol. 2013 Jan; 32(1):22–7.

39. Li J, Zhang H, Chen Z, Su K. Clinico-pathological characteristics and prognostic factors of gastrointestinal stromal tumors among a Chinese population. Int J Clin Exp Pathol. 2015; 8(12):15969–76.

40. Ud Din N, Ahmad Z, Arshad H, Idrees R, Kayani N. Gastrointestinal Stromal Tumors: A Clinicopathologic and Risk Stratification Study of 255 Cases from Pakistan and Review of Literature. Asian Pac J Cancer Prev. 16 (12), 4873-4880.

41. Sui XL, Wang H, Sun XW. Expression of DOG1, CD117 and PDGFRA in gastrointestinal stromal tumors and correlations with clinicopathology. Asian Pac J Cancer Prev. 2012 Jan ; 13(4):1389–93.

42. Kang YN, Jung HR, Hwang I. Clinicopathological and immunohistochemical features of gastointestinal stromal tumors. Cancer Res Treat. 2010; 42(3):135–43.

43. Klieser E, Pichelstorfer M, Weyland D, Kemmerling R, Swierczynski S, Dinnewitzer A, et al. Back to the start: evaluation of prognostic markers in gastrointestinal stromal tumors. Molecular and clinical oncology. 2016; 4(5): 763–73.

44. Alqusous ST, Rabadi OJ, Omari A, Abbasi N, Haddadin SW, Rawabdeh S, et al. Clinicopathologic spectrum of gastrointestinal stromal tumours; six years experience at King Hussein Medical Center. JRMS. 2016 Mar; 102(3019):1–6.

45. Tazawa K, Tsukada K, Makuuchi H, Tsutsumi Y. An immunohistochemical and clinicopathological study of gastrointestinal stromal tumors. Pathol Int. 1999 Sep; 49(9):786–98.

46. Lopes LF, Ojopi EB, Bacchi CE. Gastrointestinal stromal tumor in Brazil: clinicopathology, immunohistochemistry, and molecular genetics of 513 cases. Pathol Int. 2008 Jun; 58(6):344–52.

47. Salih FM, Rasul KI. Epidemiology and tumor characteristics of gastrointestinal stromal tumors in KRG territories. Adv Mod Oncol Res. 4(2): 285.

48. Hui CA, Zhang Y, Ming WA, Shen DP, Sheng ZY, Ni XZ, WU ZY, Qiang LI, Shen YY, Song YY. Prognostic analysis of patients with gastrointestinal stromal tumors: a single unit experience with surgical treatment of primary disease. Chinese medical journal. 2010 Jan 20;123(2):131-6.

49. Muhammad ZR, Norra H, Suhaila A, Norlelawati AT, Naznin M. A Review of Gastrointestinal Stromal Tumours-A Single Centre Experience. IIUM Medical Journal Malaysia. 2016 Nov 26;15(2).

50. Kassem MI, Elzeiny MM, Elhaddad HM. Management of gastrointestinal stromal tumors: a prospective and retrospective study. Egyptian J Surgery. 2016 Jan; 35(1):11–19.

51. Park CH, Kim GH, Lee BE, Song GA, Park DY, Choi KU, et al. Two staging systems for gastrointestinal stromal tumors in the stomach: which is better BM? C Gastroenterology. 2017 Dec; 17(1):14152. Kim H, Oh SJ, Koo MY, Hong JJ, Koh YT, Choi MG, et al. Gastric gastrointestinal stromal tumor: Does the newly proposed UICC TNM staging system provide better prognostic ability than the National Institutes of Health consensus criteria? Korean Journal of Clinical Oncology. 2016 Dec; 12(2):83-90.

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