Gastrointestinal Stromal Tumours: Review of 150 Cases from a Single Centre

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal tract. They constitute a significant percentage ranging from 1-2 % of all the gastrointestinal neoplasms [11]. Knowledge on the molecular biology and behavior of these tumours is still not very clear. The clinicopathologial features are variable and surgical resection with chemotherapy is the main modality of treatment. We have retrospectively analyzed the clinicopathological features, treatment and prognosis of 150 patients managed in the Department of Surgery. Retrospective review of the records of 150 patients diagnosed with gastrointestinal stromal tumours and managed during the period January 2006 to December 2011. Clinicopathological features, immunohistochemistry, mitotic index, surgical resection adjuvant chemotherapy and survival analyzed. One hundred and fifty patients diagnosed with GIST and treated were reviewed. Ninety five of them were males (63.3 %). The tumour was most commonly seen during the fourth and fifth decades of life. Abdominal pain (52 %), intestinal bleeding (40 %) and abdominal mass (25 %) were the common clinical symptoms. Sixty percent of the tumours (90/150) were located in the stomach followed by small bowel (20 %) and duodenum (14.6 %). One hundred and thirty-five patients underwent excision of the tumour and five patients had multi organ resection of the adjacent organs like spleen, tail of the pancreas and kidney. Fifteen patients (10 %) received neoadjuvant Imatinib for down staging of the tumour prior to surgery. The tumour size ranged from 1 to 34 cm. One third of the tumours (42/150) belonged to the high-grade category. KIT protein (CD117) was positive in 90 %( 135/150), while CD34 was positive in 50 % (74/150) of tumours. Majority of the patients with high and intermediate-risk category received adjuvant Imatinib (65/77). Seventeen patients (11.3 %) developed recurrence of the tumour on follow-up and rest of the patients had stable disease. Eight of the 15 patients (53 %) who had advanced disease developed recurrence of the disease over 6 months to 1 year. Fifteen patients died on follow-up between 2 and 5 years. Gastrointestinal tumours are the most common non epithelial tumour of the GIT. GISTS are found to show a male preponderance and are common during the fourth and fifth decades. Abdominal pain and intestinal bleeding are the most common clinical presentation. Most of the tumours were located in the stomach. Surgical resection is the best modality of treatment for operable lesions. Tyrosine kinase receptor (KIT) inhibitor like imatinib is used for adjuvant treatment. Regular follow-up with ultra sonogram or computed tomogram helps in diagnosing disease recurrence.