Clinicopathological and morphological spectrum of gastrointestinal stromal tumours on multi-detector computed tomography
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Submission date: 2018-02-10
Final revision date: 2018-04-06
Acceptance date: 2018-10-22
Publication date: 2018-12-28
Pol J Radiol, 2018; 83: 610-618
To describe the clinicopathological and morphological features of gastrointestinal stromal tumours (GISTs) on multi-detector computed tomography (MDCT).

Material and methods:
MDCT (plain and post contrast) images of 25 confirmed cases of GISTs were retrospectively evaluated from our hospital database. The images were analysed for the location, size, growth pattern, attenuation pattern, relation to adjacent structures, presence or absence of ulceration, calcification, metastases, lymphadenopathy, and for any complications such as haemorrhage, intestinal obstruction, etc. Institutional Ethics Committee clearance was obtained prior to the commencement of the study. Statistics used included percentage frequency.

Our study group comprised 14 males and 11 females. The mean age of our study population was 60 years (age range: 40 to 82 years). The mean tumour size was 11.7 cm. The stomach and small bowel accounted for 76% of the primary tumour site. The commonest imaging appearance of GIST observed in our study was that of an exophytic mass (76%) with a heterogenous pattern of enhancement (96%) with intratumoural necrosis (76%). MDCT demonstrated complications in three patients (12%). Six patients presented with metastatic foci (five to the liver and one to the lung), while lymphadenopathy was observed in five patients (20%). Associated complications included intestinal obstruction (8%) and retrogastric haematoma (4%). Incidental findings included uterine fibroid (n = 1), ovarian dermoid (n = 1), and chronic pancreatitis (n = 1).

GISTs are predominantly large tumours with a well circumscribed and exophytic pattern on MDCT, with or without cystic/necrotic areas, and they mostly show a heterogenous pattern of enhancement on post-contrast administration.

Hasegawa T, Matsuno Y, Shimoda T, et al. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 2002; 33: 669-676.
Mazur MT, Clark HB. Gastric stromal tumors, reappraisal of histiogenesis. Am J Surg Pathol 1983; 7: 507-519.
Dematteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors; recurrence pattern and prognostic factors for survival. Ann Surg 2000; 231: 51-58.
Kim HC, Lee JM, Kim KW, et al. Gastrointestinal stromal tumors of the stomach: CT findings and prediction of malignancy. AJR Am J Roentgenol 2004; 183: 893-898.
Burkill GJ, Badran M, Al-Muderis O, et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 2003; 226: 527-532.
Marrari A, Wagner AJ and Hornick JL. Predictors of response to targeted therapies for gastrointestinal stromal tumors. Arch Pathol Lab Med 2012; 136: 483-489.
Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet 2013; 382: 973-983.
Daghter R, Cohen M, Williams G, et al. Imatinib mesylate in the treatment of metastatic and/or unresectable malignant gastrointestinal stromal tumours. Clin Cancer Res 2002; 8: 3034-3038.
Behrenwala KA, Spalding D, Wotherspoon A, et al. Small bowel gastrointestinal stromal tumours and ampullary cancer in Type I neurofibromatosis. World J Surg Oncol 2004; 7: 1-4.
Caterino S, Lorenzon L, Petrucciani N, et al. Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol 2011; 9: 13.
Ulusan S, Koç Z. Radiologic findings in malignant gastrointestinal stromal tumors. Diagn Interv Radiol 2009; 15: 121-126.
Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002; 347: 47280.
Miettinen M, Lasota J. Gastrointestinal stromal tumors: Definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001; 438: 1-12.
Demetri GD, Benjamin R, Blanke CD, et al. NCCN task force report: optimal management of patients with gastrointestinal stromal tumors (GIST) – expansion and update of NCCN clinical practice guidelines. J Natl Compr Cancer Netw 2004; 2: S1-S26.
Sandrasegaran K, Rajesh A, Rydberg J, et al. Gastrointestinal stromal tumors: clinical, radiologic, and pathologic features. AJR Am J Roentgenol 2005; 184: 803-811.
Levy AD, Remotti HE, Thompson WM, et al. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. RadioGraphics 2003; 23: 283-304.
Li YZ, Wu PH. Conventional radiological strategy of common gastrointestinal neoplasms. World J Radiol 2015; 7: 7-16.
King DM. The radiology of gastrointestinal stromal tumours (GIST). Cancer Imaging 2005; 5: 150-156.
Bartolotta TV, Taibbi A, Midiri M, Lagalla R. Focal liver lesions: contrast-enhanced ultrasound. Abdom Imaging 2009; 34: 193209.
Kochhar R, Manoharan P, Leahy M, Taylor MB. Imaging in gastrointestinal stromal tumours: current status and future directions. Clin Radiol 2010; 65: 584-592.
Suster S. Gastrointestinal stromal tumors. Semin Diagn Pathol 1996; 13: 297-313.
Chourmouzi D, Sinakos E, Papalavrentios L, et al. Gastrointestinal stromal tumors: a pictorial review. J Gastrointestin Liver Dis 2009; 18: 379-383.
Ghanem N, Altehoefer C, Furtwängler A, et al. Computed tomography in gastrointestinal stromal tumors. Eur Radiol 2003; 13: 1669-1678.
Catalano O, De Lutio di Castelguidone E, Nunziata A, et al. Gastro­intestinal stromal tumours: Pictorial review. Radiol Med 2005; 110: 484-491.
Lau S, Tam KF, Kam CK, et al. Imaging of gastrointestinal stromal tumour (GIST). Clin Radiol 2004; 59: 487-498.
Nilsson B, Bumming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era: a population-based study in western Sweden. Cancer 2005; 103: 821-829.
Hortan KM, Juluru K, Montogomery E, et al. Computed tomography imaging of gastrointestinal stromal tumors with pathology correlation. J Comput Assist Tomogr 2004; 28: 811-817.
Jiang ZX, Zhang SJ, Peng WJ, Yu BH. Rectal gastrointestinal stromal tumors: imaging features with clinical and pathological correlation. World J Gastroenterol 2013; 19: 3108-3116.
Hasegawa S, Semelka RC, Noone TC, et al. Gastric stromal sarcomas: correlation of MR imaging and histopathologic findings in nine patients. Radiology 1998; 208: 591-595.
Tang L, Zhang XP, Sun YS, et al. Gastrointestinal stromal tumors treated with imatinib mesylate: apparent diffusion coefficient in the evaluation of therapy response in patients. Radiology 2011; 258: 729-738.
Zhou HY, Zhang XM, Zeng NL, et al. Use of conventional MR imaging and diffusion-weighted imaging for evaluating the risk grade of gastrointestinal stromal tumors. J Magn Reson Imaging 2012; 36: 1395-1401.
Jager PL, Gietema JA, van der Graaf WT. Imatinib mesylate for the treatment of gastrointestinal stromal tumours: best monitored with FDG PET. Nucl Med Commun 2004; 25: 433-438.
Van den Abbeele AD, for the GIST Collaborative PET Study Group DanaFarber Cancer Institute, Boston, Massachusetts; OHSU, Portland, Oregon, Helsinki University Central Hospital, Turku University Central Hospital, Finland, Novartis Oncology. F18-FDG-PET provides early evidence of biological response to STI571 in patients with malignant gastrointestinal stromal tumors (GIST). Proc Am Soc Clin Oncol 2001; 20: 362a.
Joensuu H, Roberts PJ, Sarlomo-Rikala M, et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 2001; 344: 1052-1056.
Choi H, Charnsangavej C, de Castro Faria S, et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: A quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004; 183: 1619-1628.
Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 2012; 13: 265-274.
Rutkowski P, Gronchi A, Hohenberger P, et al. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors (GIST): the EORTC STBSG experience. Ann Surg Oncol 2013; 20: 2937-2943.
Gervaz P, Huber O, Morel P. Surgical management of gastrointestinal stromal tumours. Br J Surg 2009; 96: 567-578.
Lin J, Huang C, Zheng C, et al. Laparoscopic versus open gastric resection for larger than 5 cm primary gastric gastrointestinal stromal tumors (GIST): a size-matched comparison. Surg Endosc 2014; 28: 2577-2583.
Liu B, Song J, Qu B, et al. Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc 2012; 26: 3141-3148.
Schmidt A, Bauder M, Riecken B, et al. Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series. Endo­scopy 2015; 47: 154-158.
ESMO/European Sarcoma Network Working Group: Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 (Suppl 3): iii21-iii26.
Garner AP, Gozgit JM, Anjum R, et al. Ponatinib inhibits polyclonal drug-resistant KIT oncoproteins and shows therapeutic potential in heavily pretreated gastrointestinal stromal tumor (GIST) patients. Clin Cancer Res 2014; 20: 5745-5755.
von Mehren M, George S, Heinrich MC, et al. Results of SARC 022, a phase II multicenter study of linsitinib in pediatric and adult wild-type (WT) gastrointestinal stromal tumors (GIST). J Clin Oncol 2014; 32 (Suppl): abstr 10507.
Yamanaka T, Takaki H, Nakatsuka A, et al. Radiofrequency ablation for liver metastasis from gastrointestinal stromal tumor. J Vasc Interv Radiol 2013; 24: 341-346.
Wright CL, Werner JD, Tran JM, et al. Radiation pneumonitis following yttrium-90 radioembolization: case report and literature review. J Vasc Interv Radiol 2012; 23: 669-674.
Takaki H, Litchman T, Covey A, et al. Hepatic artery embolization for liver met astasis of gastrointestinal stromal tumor following imatinib and sunitinib therapy. J Gastrointest Cancer 2014; 45: 494-499.
Choi YR, Kim SH, Kim SA, et al. Differentiation of large (≥ 5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: radiologists’ performance using CT. Eur J Radiol 2014; 83: 250-260.
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