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

2. 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 – 701
N Eng J Med :
Eisenberg BL,Judson I.Surgery and imitanib in the management of GIST:emerging approaches to adjuvant and neoadjuvant therapy.Ann Surg Oncol 2004;11:

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

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

5. 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

6. 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

7. 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.

8. 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%

9. 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%

10. 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

11. OGD

12. OGD

13. OGD

14. OGD

15. 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:

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

17. EUS

18. 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

19. Thank You
ألاستاذ د منعم ألشوك