Open in another window Table 2 Requirements for risk stratification GISTS are usually located on the intestinal level (30% of GIST) possess a more intense behavior in comparison to those located on the gastric level (60% of most GIST) that have the same proportions and variety of mitoses

Open in another window Table 2 Requirements for risk stratification GISTS are usually located on the intestinal level (30% of GIST) possess a more intense behavior in comparison to those located on the gastric level (60% of most GIST) that have the same proportions and variety of mitoses. in the journal. Each one of these data extracted from the books have already been integrated within a working experience of 19 situations of GIST, controlled in the medical clinic within the last ten years for which we’ve proposed an modified diagnostic algorithm. solid course=”kwd-title” Keywords: GIST, diagnostic algorithm, treatment, hereditary analysis, surveillance Launch Gastrointestinal stromal tumors (GISTs) are uncommon tumors, ( 1% of digestive system tumors) with an occurrence approximated at 1.5/100,000/year [1]. The occurrence pertains and then manifested situations medically, while microscopic lesions could be discovered just at a histopathological evaluation. GIST arise from interstitial cells explained by Cajal and they are characterized by mutations of the c-KIT and PDGFRA genes which determine oncogenesis on one hand and the possibility Monodansylcadaverine of a precise diagnosis and targeted treatments through specific molecules, on the other hand. The average age of occurrence of the disease is usually 60-65 years, with wide margins. Monodansylcadaverine GIST are very rare in children, and represent a distinct subset of these diseases, characterized by: female predominance, KIT/PDGFRA Mapkap1 mutations absence, multicentric gastric location and possible lymphatic Monodansylcadaverine metastasis [2]. In short, 4 major GIST groups are explained: 1. GIST KIT mutated that occur with different locations and represent the major subgroup (85% of GIST) [3]. 2. GIST PDGFRA mutated (5-8% of GIST) that occur generally as gastric epithelioid tumors often giant, but with favorable prognosis [4,5]. 3. Pediatric GIST (Carney-type: Carney triad C gastric GIST, paraganglioma, pulmonary chondromas, Carney-Stratakis dyad – GIST, paraganglioma) developed in children or adults, are distincted clinical and molecular forms [6-8]. 4. Neurofibromatosis, type I: characterized mainly by GIST wild-type; other mutations than KIT or PDGFRA, with intestinal predominant localization and possible multiple and with favorable prognosis [9]. At the Esophageal and General Surgery Medical center of “Sf. Maria” Hospital in Bucharest the first case with GIST was recorded 10 years ago. Since then, the series of patients have reached 19 (12 with gastric localization, 6 with intestinal localization and 1 with pancreatic localization), a series comparable to comparable centers. The disease was symptomatic: abdominal aches and pains, anemia, fatigue, palpable tumor, upper digestive hemorrhage or intestinal obstruction. The imaging used pre and post operating consisted in esogastric barium transit, upper digestive endoscopy, abdominal echography (ECO), computed tomography (CT), positron emission tomography (PET). Confirmation was made through anatomo-pathological and immunohistochemistry examinations (Fig. 1,?,22). Open in a separate windows Fig. 1 Giant intestinal GIST – intraoperative image Department of General and Esophageal Surgery “Sf. Maria” Hospital photo collection Open in a separate windows Fig. 2 Aspects of microscopic histopathology (left-hematoxylin-eosin, 20X, right-imunohistochemistry (CD117+) Department of Anatomopathology “Sf. Maria” Hospital For some of the patients, the study by sequencing the oncogenes mutations and clinical-pathological correlation was managed. All patients received more or less extensive surgical resections. For some of the patients, a specific adjuvant treatment has been applied. All patients survived the surgeries. Surgery interest towards this pathology, the collaboration with the “Sf. Maria” Hospital Department of Anatomopathology Bucharest and those of Anatomopathology of “Victor Babes” National Institute of Pathology, the contribution of the oncologists trained in the treatment of this disease has allowed the centralization and comparison of data obtained as well as the communication of the results in medical journals [10-12]. Accumulating experience of other surgical centers requires the integration of all information and matching GIST management in line with international recommendations. Diagnosis of GIST Clinical guideline on the diagnosis of GIST is usually suggested by the presence of a large tumor often paucisymptomatic, or with a non-specific symptomatology, with long time development, Monodansylcadaverine not being accompanied by an altered general state, specific in neoplasia. Diagnostic approach differs in GIST, being mainly linked to the size of the tumor (Fig. 3). Open in a separate windows Fig. 3 Diagnostic algorithm in GIST Thus, for nodules under 2 centimeters, the standard approach is.