Biological behavior due to cell proliferation markers of gastrointestinal stromal tumors.

General Surgery and Digestive System, General Hospital, Tomelloso Avenue, 13005, Ciudad Real, Spain.
Hepato-gastroenterology (Impact Factor: 0.77). 01/2011; 58(105):76-80.
Source: PubMed

ABSTRACT The mitotic index and tumor size are currently the main prognostic indicators of gastrointestinal stromal tumors (GIST). The purpose of this study is to investigate the expression of different immunohistochemical markers and their relation to mortality and relapse, and especially concerning high-risk tumors.
We did a retrospective study of 68 patients who underwent surgery from 1997 to 2007 with a diagnostic of gastrointestinal stromal tumor.
The median follow-up period was 29 months. Relapse and mortality rates were 35.3% (24 cases) and 41.2% (28 cases), respectively. The mitotic index was related to p53 and the cellular proliferation index -Ki67- (p = 0.006 and p = 0.003, respectively). Considering both high and intermediate-risk neoplasms, a significant relation to Ki67 was obtained (p = 0.008). Relapse was related to the mitotic index (p = 0.032) and Ki67 (p = 0.024). Concerning mortality, statistically significant results were obtained with necrosis variables (p = 0.02), mitotic index (p = 0.013), p53 (p = 0.024) and Ki67 (p = 0.033).
Ki67 could be considered a prognostic marker for both relapse and mortality. Concerning high risk GIST, the usefulness the p53 protein and Ki67 nuclear antigen markers was also evident concerning relapse and mortality.

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    ABSTRACT: Objective Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the gastrointestinal tract. We report a case of gastrointestinal stromal tumor in a small intestine, initially suspected for leiomyosarcoma given that gastrointestinal stromal tumors in young patients are limited due to their rarity. Method A 30-year-old Caucasian ethnic Albanian female from Kosovo presented with abdominal pain, nausea and vomiting. Subsequently, the tumor was detected in the small intestine, as an infiltrating mass approximately 10 cm in diameter. The tumor has been resected en bloc and the duodenojejunal terminal-terminal anastomosis has been performed. Results The tumor was large, intramural mass, with fish-flesh to tan-brown appearance, as well as with foci of hemorrhage and necrosis. Histologically, the tumor showed transmural growth, deep infiltrative pattern and malignant feature, with dense cellularity, plump spindle cells, within variably hyalinized and edematous stroma. In addition, tumor was composed of frequent areas with epitheloid morphology. The immunohistochemistry results showed high expression of c-KIT (CD117), CD34 and Vimentin, whereas α-smooth muscle actin was focally positive. Desmin and S100 protein were negative. Conclusion Given, that GIST in young adults represents a more heterogeneous group, there should be made more efforts in investigating its pathogenesis and potential more specific treatment.
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