ObjectiveTo explore the value of ultrasonography in the diagnosis of gastrointestinal stromal tumors (GISTs). MethodWe retrospectively analyzed the clinical data of 110 patients with surgical pathology confirmed GISTs between January 2008 and December 2013. All the patients underwent routine ultrasound examination. Thirty-two patients accepted oral contrast enhanced bowel ultrasonography, and 5 patients underwent trans-rectal ultrasound (TRUS). ResultsA total of 107 cases were detected out of the 110 cases of GISTs by ultrasonography, and the other three cases were missed. Among the 107 cases, 104 were shown to be masses, and 3 had thick gastric or intestinal walls. Among the 104 masses, hypo-echoic lesions were found in 73, heterogeneous lesions were found in 25, and hyper-echoic lesions were found in 6; 30 cases of tumor were less than 5 cm in diameter, 54 were between 5 cm to 10 cm in diameter, and 20 were longer than 10 cm in diameter (including 5 were longer than 20 cm in diameter). In the 107 cases, 12 were found to have liver metastasis, 4 were detected to have abdominal lymph node enlargement, and 3 had ascites. Surgery and pathological results showed that among the 110 cases of gastrointestinal stromal tumors, 91 developed from the stomach and intestine and the other 19 were extra-gastrointestinal stromal tumors; 72 were at high risk, 21medium risk, and 17 low risk. ConclusionsThe detection rate of GISTs by ultrasonography is high, but the quantitative and qualitative diagnosis ability should be raised.
Objective To detective KRAS and BRAF mutations in gastrointestinal stromal tumors (GISTs) and explore its significance in resistance of imatinib treatment. Methods Three hundred and eighty-one c-kit/PDGFRA mutation samples, 119 c-kit/PDGFRA wild type samples, and 19 pairs of samples before and after imatinib resistance from 519 patients with GIST were enrolled in this study. Polymerase chain reaction was used to detect KRAS exon 2 and BRAF exon 15 mutations. The survival data were evaluated in patients with KRAS or BRAF mutation. Results KRAS mutation was found in 2 cases (1.7%) of c-kit /PDGFRA wild type GISTs, the type of KRAS mutation was G12D and G12C, respectively. BRAFV600E mutation was found in 2 cases (1.7%) of wild type GISTs. No KRAS and BRAF mutations were found in the patients with the c-kit/PDGFRA mutation GISTs and pairs of GISTs before and after imatinib resistance. Two patients with KRAS mutation showed shorter progression free survivals for imatinib treatment. Two patients with BRAF mutation had longer recurrence free survivals. Conclusions Low frequency of KRAS or BRAF mutation only happens in wild type GISTs. KRAS mutation might be related to imatinib primary resistance, but not to secondary resistance.
Carney triad is a rare tumor syndrome with few reports. This case showed the enhanced CT and MRI images of a rare young woman patient with Carney triad (containing gastric stromal tumor, renal cell carcinoma, adrenal pheochromocytoma, and pulmonary chondrosarcoma), which is intended to provide a reference for clinical diagnosis and differential diagnosis. This case reminds the radiologists and clinicians that the patients with a history of primary gastrointestinal stromal tumor and neoplastic lesions occurring at specific sites (pulmonary chondrosarcoma, adrenal pheochromocytoma, renal cell carcinoma, etc.) need to be alerted to the possibility of combining with Carney triad.
Objective To analyze features of color Doppler ultrasonography in gastrointestinal stromal tumors. Method The ultrasound images of gastrointestinal stromal tumors (51 cases) and gastrointestinal cancers (59 cases) confirmed by operation and pathology were compared and analyzed. Results The gastric stromal tumor mainly occurred at the bottom of the stomach and the body of the stomach (17 cases), the intestinal stromal tumor mainly occurred at the small intestine (24 cases). The gastric cancer mainly occurred at the gastric antrum (18 cases), the intestinal cancer all occurred at the colon (20 cases) and rectum (12 cases). Compared with the gastrointestinal cancers, the gastrointestinal cavity was not surrounded by tumor, the peripheral boundary was clear, the morphology was more regular, the internal echo was uneven, and there was no peripheral lymph node metastasis in the gastrointestinal stromal tumors, the differences were statistically significant (P<0.05). There were no significant differences in the degree of blood flow and tumor diameter between the gastrointestinal stromal tumors and the gastrointestinal cancers (P>0.05), but the blood flow of the intestinal stromal tumor was significantly more abundant as compared with the intestinal cancer (P<0.05). Conclusion Color Doppler ultrasonography, as a simple and rapid method, has a certain diagnostic value for differentiation of gastrointestinal stromal tumors and gastrointestinal cancers.
ObjectiveTo detect expressions of E-cadherin (E-cad) and vascular endothelial growth factor (VEGF) in gastrointestinal stromal tumor (GIST) tissues and analyze their relationships with clinicopathologic features of patients with GIST.MethodsForty paraffin-embeded specimens of surgical resected GIST from January 2015 to March 2018 in the Pathology Department of Yuhuangding Hospital Affilicated to Qingdao University were retrieved. The expressions of E-cad and VEGF proteins were detected by the immunohistochemical method.ResultsThe positive expression rates of E-cad and VEGF proteins in the GIST tissues were 10.0% (4/40) and 50.0% (20/40), respectively. The positive expression rates of E-cad and VEGF proteins were associated with the tumor diameter, mitotic counts, and risk classification (P<0.05). The positive expression rate of the E-cad was negatively related to that of the VEGF in the GIST tissues (rs=–0.55, P=0.001).ConclusionFrom results of this study, VEGF and E-cad might be related with malignancy of GIST, which might be potential facators in predicting prognosis of GIST.
目的 探讨甲磺酸伊马替尼治疗胃肠道间质瘤对患者细胞免疫功能的影响。方法 对病理诊断明确的16例行甲磺酸伊马替尼治疗的胃肠间质瘤患者的CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平进行回顾性分析比较。结果 16例接受严格甲磺酸伊马替尼治疗的患者，其CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平在甲磺酸伊马替尼治疗前、后无明显变化（Pgt;0.05）。结论 采用甲磺酸伊马替尼在对胃肠间质瘤患者进行分子靶向治疗时，对患者的细胞免疫功能无明显影响。
ObjectiveTo explore the clinical characteristics, diagnosis, and treatment norms of gastrointestinal stromal tumor, so as to deepen clinicians’ understanding of the gastrointestinal stromal tumor and avoid misdiagnosis.MethodsThe clinical data of a patient with gastrointestinal stromal tumor who treated in March 2019 in The First Hospital of Kunming was retrospectively analyzed, and determining the methods of the treatment through MDT mode.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, cardiothoracic surgery department, oncology department, and anesthesia department, it was considered that surgical treatment was the best treatment scheme. The operation time was 120 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroesophageal reflux, and other complications occurred after the operation, and the patient was discharged successfully on the 10th day after the operation. Postoperative treatment was assisted by imatinib. Follow-up was conducted for more than 4 months, with no obvious complication occurred after discharge, so continued to follow-up.ConclusionGastrointestinal stromal tumor can be diagnosed and treated by multidisciplinary approach, and surgical resection is still the most important and effective treatment.
Objective To describe pharmacokinetic of imatinib in a cohort of gastrointestinal stromal tumor (GIST) patients in routine clinical care from West China Hospital of Sichuan University. Methods The imatinib trough concentration (Cmin) in 42 patients with GIST who were taking imatinib in routine clinical care setting in West China Hospital from 2010 to 2016 was measured. The clinical features and follow-up data were collected. Results The mean imatinib Cmin in 42 patients was 1 757 μg/L (199–7 435 μg/L), 10 of 42 patients presented with Cmin values was lower than 1 000 μg/L. The imatinib Cmin of 18 patients received an imatinib dose of 300 mg/d or 24 patients treated with 400 mg/d imatinib was (1 313±479) μg/L and (1 775±1 520) μg/L, respectively (P=0.222), but the rate of low Cmin (lower than 1 000 μg/L) in the two different dose groups had no significant difference (P=0.347). In Cox regression, no statistically significant association between the low Cmin and the time to progression of GIST could be demonstrated 〔HR=0.171, 95%CI：(0.106, 12.990),P=0.898〕. Conclusion The preliminary results of limited cases in this study show that some GIST patients are systematically underexposed in routine clinical care, an individualized treatment based on monitoring of imatinib Cmin is likely to be more efficient than a fixed-dose treatment.
Objective To investigate preoperative blood neutrophil-to-lymphocyte ratio （NLR） in patients with gastrointestinal stromal tumor （GIST） and analyze the relationship of the NLR to prognosis. Methods The data of NLR of peripheral blood samples on 3d before surgery and the results of immunohistochemistry of 42 patients with GIST were analyzed respectively，the relation between the NLR and the prognosis of patients with GIST was understood by the survival analysis. Results The patients with high NLR （NLR≥2.5） was found in 22 cases， low NLR （NLR＜2.5） in 20 cases.The NLR was related to mitotic figures （χ2=9.45，P=0.002） and tumor size （P=0.041）. The 3-year survival rate of the patients with high NLR was shorter than that of the low NLR （χ2=5.44，P=0.022）. The 3-year survival rate was associated with NLR，mitotic figures，and tumor size （P＜0.05） in univariate analysis. The NLR and mitotic figures were independent prognostic indicators of 3-year survival （P=0.018，P=0.000） in Cox multivariate analysis. Conclusion Blood NLR and mitotic figures have some predictive value for the prognosis of patients with GIST.
ObjectiveTo investigate the current status and influencing factors of medical coping strategies in patients with gastrointestinal stromal tumors (GIST). MethodsA convenience sampling method was used to select 181 GIST patients who visited the First Affiliated Hospital of Nanjing Medical University from September 2022 to May 2024. The fear of progression questionnaire (FoP), brief illness perception questionnaire (BIPQ), social support rating scale (SSRS), and medical coping modes questionnaire (MCMQ) were administered for data collection. Multiple linear stepwise regression analysis was conducted to explore the influencing factors of the three types of medical coping strategies. ResultsMultivariate linear stepwise regression analysis showed that patients without tumor metastasis (P=0.016) and high support utilization (P=0.006) had higher score of confrontation coping. Patients with high education level (P=0.016) and subjective support (P=0.002) had higher score of avoidance coping. Patients with lower fear of physical health deterioration (P=0.003), high education level (P=0.010) and subjective support (P=0.027) had higher score of submission coping.ConclusionsThe influencing factors of medical coping strategies in GIST patients are complex, involving social support, disease-related fear, tumor metastasis, and education level. Providing comprehensive GIST-related knowledge and information to patients may help establish correct health beliefs and attitudes.