Gastrointestinal stromal tumours. Our experience ten years later

To analyze GISTs behaviour observing their clinical evolution and outline the best approach to this neoplasia.

In a period between December 1999 and October 2009 came to our observation, at the Institute of General Surgery, 37 patients with GIST. We conducted a retrospective study evaluating the anatomo-pathological aspects, the clinical situation and the tumour characteristics of the 37 patients with GIST.

The 37 patients included 21 women (57%) and 16 men (43%), the mean age was 67 years. GISTs originated from the stomach (27), jejunum (5), ileum (3), anus (1) and transverse mesocolon (1), the symptom most frequently found was acute anaemia and in 5 cases the diagnosis was occasional; 36 patients underwent surgical treatment. Based on tumor size, mitotic count, presence of areas of necrosis and/or haemorrhage, GISTs were classified according to the categories of potential high-grade malignancy (13 pts), intermediate grade (8 pts), low grade (16 pts).

According to international literature, surgery remains the cornerstone of treatment for patients with primary resectable GIST without evidence of metastasis and should also be utilized when surgery has minimal risk of morbidity for the patient. The goal of surgery is complete surgical resection with negative margins (R0). The follow-up for some patients is still ongoing; only 10 patients underwent to adjuvant therapy with Imatinib.

In the last decade, GISTs have become an emblematic example of the possibility of pharmacologically interfering with the molecular mechanisms of carcinogenesis.