Malignant gastrointestinal stromal tumors of the stomach

ABSTRACT

Stromal or mesenchymal neoplasms affecting the gastrointestinal [GI] tract are divided into two groups. The less common variety includes tumors that are identical to those that arise in the soft tissues throughout the rest of the body, including lipomas, schwannomas, hemangiomas. The second more common group consists of stromal tumors that are collectively referred to as gastrointestinal stromal tumors [GISTs]. They are most often located in the stomach and proximal small intestine. To compare the incidence, mode of presentation and management of malignant gastric GISTs of this study from Iraq with other world reports. Retrospective study of the medical records of 1037 patients with gastric malignancies operated upon between January 1970-December 2000 were reviewed. The incidence of GISTs, their age and sex, symptomatology, diagnostic procedures, surgical management and results will be presented. Among 1037 patients with gastric malignancies, 13 [1.25%] were malignant GISTs. 6 were males and 7 females. Age ranges from 19-67 [median 58 +/- 13 .2397 SD] years. Mode of presentation were; upper GI bleeding 8 [62%], dyspepsia 4[31%] and mass one [8%] patient. Duration of illness ranges from 2 days-8 years [median 3 months +/- 25.9207 SD]. Barium study revealed a tumor in 10 out of 11 patients. Endoscopy in 12 patients reported 4 nodular, 3 fungating and 3 ulcerative tumor and two normal. Ultrasound in 8 patients showed a mass in 7 [5 intraluminal, two extraluminal] and no tumor in one. Site of tumor were the; lesser curve 4[31%], antrum 3[23%], greater curve 2[15%], fundus 2[15%], body one [8%] and cardia one [8%] patient. Grossly the tumors were; fungating 5, nodular 2, ulcerative one, nodular-cystic 3 and nodular-ulcerative in 2. The tumor size vary from 5x3 - 17x12 [mean 9.69231 +/- 3.727793 SD x 7.69231 +/- 2.95479 SD] cm. Gastric resections were; upper 5, segmental 4, subtotal 2 and lower 2 patients. Chemotherapy and/or radiotherapy were given to advance or those with metastasis. Histopathology reported low-grade malignancy in 5 and high-grade in 8 patients. According unified 1997 TNM staging were; I 2, II 4, III 3 and IV 4 cases. Two-years survival was 69% [9 out of 13] and 5-years was 46% [6 out of 13]. Malignant GISTs constitute 1.25% of all gastric malignancies. No gender predilection found. Median age 50.3 years. Recurrent upper GI bleeding in 62% and dyspepsia in 31%. No specific symptoms but abdominal mass in 4 cases. Barium study, endoscopy and US were the diagnostic procedures. Tumors were; mostly intraluminal, fungating nodular and large [median 8x8 cm]. Resection was the treatment. 5 were low-grade and 8 high-grade malignancy. 2 and 5-years survival were 62% and 46% respectively