Surgery | 2021
Gastric GIST with progressive mitotic index
Abstract
Gastrointestinal stromal tumors (GISTs) account for less than 1% of gastrointestinal\ntumors;they are the most common mesenchymal neoplasms of the gastrointestinal(GI) tract. GISTs are\nusually located in the stomach,but can occur anywhere along the gastrointestinal tract.GIST ranks third as\nhistology after adenocarcinomas and lymphomas among the gastrointestinal tract.Case presentation.The\npatient, aged 58 years, is transferred from the Gastroenterology Clinic with symptoms of stenosis and\nhemorrhage from a endophytic submucosal tumor located on the posterior gastric wall, under the eso-gastric\njunction, objectified endoscopically and CT scan. Laparoscopic wedge resection was performed with three\nlinear Endo-GIA staplers. The evolution was favorable. After 7 months (without chemotherapy because pTNM\nwas T1NoMo), the patient is sent back by the gastroenterologist for „CT scan:perigastric lymphadenopathies”.\nThe patient was operated laparoscopically converted.We found 10 tumors with typical malignant GISTs 3-10\ncm diameter,on the peritoneal serosa:in the right subhepatic space, perigastric, left interhepato-phrenic,\nhepato-gastric;these were excised R0; with simple evolution. The immuno-histo-chemical examination\nspecifies the diagnosis of GIST at the first and the second operation (DOG1,CD117,CD34-positively in\ntumor).Ki 67 was 15% in the tumor and the mitotic index <5/5 square mm at the moment of the first operation\nbut in the metastatic tumor at the reintervention Ki 67 was 80% and mitotic index >5/5 square\nmm.Discutions.GIST tumours can be classified into low-risk and high-risk categories of recurrence\ndepending on size, location, capsule rupture and mitotic activity. Disseminated metastases in the abdominal\ncavity are the most common clinical manifestations of malignancy. Complete surgical resection is\nrecommended if bleeding or other symptoms are present. Tumour perforation, spontaneous or produced at\nthe time of surgical resection, should be recorded because it has a high negative prognostic value due to\nperitoneal contamination. The average survival rate in localized disease is 5 years but in metastatic or\nrecurrent disease is about 10-20 months. Conclusion. Complete excision of residual metastatic lesions has\nbeen shown to be associated with a favourable prognosis, provided that the patient responds to imatinib\ntreatment; resection of tumour recurrence is accompanied by an average survival of 15 months. Gastric GIST\nrecurrence risk depends of localisation, tumor size, mitotic index and capsular rupture.