[Gastrointestinal stroma tumor: a surgical oncology problem child?]

Retrospectively analyzing the history of three patients with gastrointestinal stromal tumors (GIST) treated over a period of 1 year in the surgical department of our regional hospital, we tried to answer the following questions: using the current recommendations in the literature, how are the macro- and microscopic features and clinical presentation to be interpreted? Which prognostic and therapeutic conclusions should we draw, giving special consideration to practice-orientated management of such cases. The patients were 65, 75 and 88 years old respectively, and in each case the GIST manifested as recurrent gastrointestinal bleeding. During surgical treatment four gastric tumors ranging in cross section between 2.5 and 8 cm were found. The GIST diagnosis was established after light microscopic and immunohistochemical examinations. Going through the current literature, a large number of structural and immunohistochemical criteria have come to light for determining its classification and potential malignancy. On the other hand, very few subsequent recommendations concerning therapy and prognosis can be found and follow-up recommendations are almost unavailable. We conclude that GISTs are difficult to diagnose because of their locality and that their clinical behavior is uncertain. The potential malignancy, on the other hand, requires a well-founded diagnostic procedure in the form of the best possible pre-therapeutic staging. Furthermore, initially radical surgical treatment should be adopted and the follow-up should be adapted to the risk involved. The latter is arbitrary and further clinical studies are required.