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The Natural History of GIST Akira Sawaki 1 , Nobumasa Mizuno 1 , Noriyuki Hoki 1 , Tadayuki Takagi 1 , Hideki Ishikawa 1 , Tsuneya Nakamura 2 , Masahiro Tajika 2 , Hiroki Kawai 2 , Reiko Takayama 1 , Yohei Takeda 1 , Minoru Sigekawa 1 , Yugo Sawai 1 , Yuji Kobayashi 1 , Osamu Nakahara 1 , Kenji Yamao 1 1Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan 2Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan Keyword: GIST , 超音波内視鏡下穿刺吸引生検法 , EUS-FNA , 自然史 pp.199-204
Published Date 2008/2/25
DOI https://doi.org/10.11477/mf.1403101275
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 Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms with an annual incidence of approximately 10 to 20 per 1 million cases. Although pathologists have often observed incidental small GISTs in the stomach resected from patients with gastric cancer, no report on the real incidence of gastric GISTs is available. In this study, 100 whole stomachs resected from patients with gastric cancer were sectioned at 5 mm intervals and hematoxylin and eosin-stained slides (a mean of 130 slides for each case) were examined for microscopic GISTs. KIT (CD117), CD34, and desmin expression of the incidental tumors was evaluated by immunohistochemistry, and genomic DNA extracted from formalin-fixed and paraffin-embedded tumor tissues was analyzed for c-kit gene mutations in exon 11. In 35 of the 100 whole stomachs, we found 50 microscopic GISTs, all of which were positive for KIT and/or CD34 and negative for desmin. Most microscopic GISTs (45/50, 90%) were located in the upper stomach. Two of the 25 (8%) microscopic GISTs had c-kit gene mutations. Fifty-one leiomyomas with positive expression for desmin were observed in 28 of the 100 stomachs. Both leiomyomas and GISTs were found in 12 stomachs. These results indicate that microscopic GISTs are common in the upper portion of the stomach. Considering the annual incidence of clinical GISTs, only few microscopic GISTs may develop to a clinical size with malignant potential. Further studies are required to clarify the genetic events responsible for the transformation of microscopic GISTs to clinical GISTs.

 Although gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal tumors of the gastrointestinal tract, their annual incidence is approximately estimated at only 10 to 20 per 1 million cases. The natural history of GISTs hasn't been clear because the preoperative pathology assessment is thought to be difficult to confirm because the diagnosis using the core needle biopsy essential for doing it is needed after removal of any suspected GIST. To discuss the natural history, we investigated the changes in size and configuration of small GISTs that were pathologically confirmed using endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNA). Between July, 1997 and December, 2005, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed up in our hospital. The median patient age at EUS-FNA was 62 years (range 26~82) and the median follow-up period was 6.4 years (range 2.5~10.7 years). Compared to the initial diagnosis, fourteen tumors showed no remarkable changes in size or shape during follow-up. Two tumors were enlarged:one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm to 10 cm after only 2 years. Although surgical removal was performed for the latter rapid progression case, it was recurrent and death due to GIST followed. Kawamowa et al reported that microscopic GISTs were found in 35 of the 100 stomachs resected from patients with gastric cancer. Some microscopic GISTs may develop to a clinical size with a higher malignant potential, but the others may remain for a long time.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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