Dr Monem Alshok Merjan Teaching Hospital GIT centre GIST in Babylon Dr Monem Alshok Merjan Teaching Hospital GIT centre

Introduction Mesenchymal tumor arising from embryological mesoderm of gastrointestinal tract . Interstitial cell of Cajal: Common precursor? <1% of all GIT tumors, can be cancerous There is Mutation in KIT (Hirota et.al.1998) GIST is a type of soft tissue sarcoma N Eng J Med 2005 353 – 701 N Eng J Med 2014 370 : 1327 - 1334 Eisenberg BL,Judson I.Surgery and imitanib in the management of GIST:emerging approaches to adjuvant and neoadjuvant therapy.Ann Surg Oncol 2004;11:465-475

Epidemiology Incidence : Incidence15-20 per million More in Male Rarely Familial or genetic Sporadic in most of the patients

Aim: To study the behavior of this uncommon GIT tumor in our patients and the overall survival rate following medical treatment

Patients & Methods 32 patients with GIST were studied in Merjan Teaching hospital , their diagnosis made on OGD & histopathology & Immunohistochemistry . The period of the study started during the year 2013 to end of January 2015, the clinical manifestation and presentation and the main methods of treatment are studied

Results From these 32 patients with GIST,their age range from 22years to 88 years with mean of 41 , 14 are male and 18 are female making slight female preponderance .The main method of diagnosis is by OGD and two patients present with abdominal mass and anemia and the diagnosis of GIST was made after laparatomy and histopathology and immunohistochemistry using KIT & CD 34 tests

Results continued The most common clinical presentations include anemia , upper GIT bleeding and dyspepsia . All the patients were treated by Imatinib ( 30 ) and Sunitinib ( 2 ) . One patients died during the course of treatment making mortality rate of 3.1% . The overall prognosis & survival were determined by site , size and spread of tumor and 26 patients continue to receive CT during the year 2014.

Location Stomach :50% , Esophagus:5% , Small Intestine:25% , Colon and rectum:10% Extra-intestinal:10% Rubin BP. Gastrointestinal stromal tumors: an update. Histopathology 2006;48:83-96 Clin Cancer Res 9(9):2003 In our patients : Stomach 72% Intestine 20% Extraintestinal 8%

Clinical Presentation Non specific Depends on site GIST of GIT: GI bleeding & Mild anemia Others -Abd. Mass -Pain abdomen -Abd.distension -Intestinal obstruction Asymptomatic:30%

Diagnosis Most commonly involves muscularis propria Ulceration on top of a Well circumscribed tumor in over 50 % On Histopathology there is a Spindle cell type

OGD

OGD

OGD

OGD

Diagnosis depends on Clinical, U/S and pathological characteristics CT- Imaging modality of choice Endoscopic ultrasound: Small tumor MRI: Rectal GISTs PET scan: Assessment of therapy Blay JY,Bonvalot S,Casali P et al.Consensus meeting for the management of gastrointestinal stromal tumors.Ann Oncology 2005;16:566-578

CT Heterogenous appearance with central necrosis and areas of cystic degeneration King DM.The radiology of gastrointestinal stromal tumors(GIST).Cancer Imaging 2005;5:150-156

EUS

In conclusion Rare Mostly sporadic and single & there is no clear risk factor were identified . Anywhere in GI Tract- Stomach main site Evaluation by EUS, CT, PET CT Varied clinical presentation mostly GI bleed Treatment of choice TKI & , Surgery

Thank You ألاستاذ د منعم ألشوك