Gastrointestinal stromal tumors (gist)

With the opportunity of five patients we treated in our department we discuss the diagnostic and therapeutic problems that can occur with the management of stromal tumors.Materials and methods: In the time period 2001-2005 we treated 5 patients with GIST, three females and two males, with median age 58,2 years. The patients presented with non-specific dull abdominal pain (2 patients), epigastric pain, gastric distention/dyspepsia (1 patient), and lower gastrointestinal hemorrhage/anaemia (2 patients). The imaging techniques that we used as an aid for the diagnosis were: computed tomography in all patients, barium radiography of the small intestine in one patient, scintigraphy of the abdomen with Technetium 99m-labeled RBCs in one patient, endoscopy of the upper GI tract in 2 patients and colonoscopy in 2 patients. The tumors were located in the small intestine (ileum) in three patients, the stomach in one patient and the mesocolon in one patient. We performed three enterectomies with end to end anastomosis, one subtotal gastrectomy and one removal of the transverse colon and mesocolon. Three of the tumors were mainly spindle cell type, one epithelioid cell type and one mixed spindle and epithelioid cell type. 4 of the patients were CD117 and CD34 positive and one patient negative for both andibodies. One patient deceased 16 days after the operation. Two patients with tumors of the small intestine are alive at the present time 5 and 4 years respectively but we have no records of postoperative follow up. One patient 3,5 years later has no indication of tumor recurrence of the small intestine on CT. The patient with the tumor of the stomach is the only patient that received Imatinib Mesylate and continues to be diseasefree after 9 months of treatment.Conclusion: Through the review of the literature we observe that the use of imatinib represents an effective, revolutionary, target therapy for GIST. Stromal tumors is a simple form of cancer with limited genetic abnormalities and mutations and it still remains to be seen if this type of therapeutic procedure can be used in more complex and common tumors, such as the cancer of the colon and others. Also, further clinical investigation must determine the ideal dose and duration of imatinib treatment and the combination with surgical treatment and other new target therapies