Review Article

Gastrointestinal Stromal Tumors: A Review of Case Reports, Diagnosis, Treatment, and Future Directions

Table 1

Review of case reports ( 𝑛 = 3 2 ).

Age/sex/historyPublished/authorLocation of GISTsPrimary symptomTumor size (cm)Primary treatmentImmunohistochemistry/mutational analysisPathologyPostop. imatinib/sunitinib treatmentRelapse

25 y.o./F1/2009/Scherjon et al. [17]DuodenumPalpable mass 1 7 × 1 6 × 5 ; 1 3 × 8 × 3 . 5 Surgical(+) CD117/c-kit; weakly (+) MS-actin and SM-actinSpindle cellsNoYes, 6 years after surgery
74 y.o./F1/2009/Terada [8]UterusPelvic pain 1 3 × 1 5 × 1 2 Surgical(+) CD117/c-kit; weakly (+) PDGFRASpindle cellYes (I)No, 2 years after treatment
52 y.o./F11/2009/Trabelsi et al. [18]PancreasEpigastric pain 1 0 . 5 × 7 × 3 Surgical(+) CD117/c-kit; (+) CD34Mixed Spindle-epithelioid cellsNoNo, 10 months after surgery
58 y.o./F1/2008/Papaspyros and Papagiannopoulos [19]EsophagusPleuritic chest pain10 in dia.Surgical(+) CD117/c-kit; (+) CD34Spindle-shaped cells; >5/50 hpfNot reportedNot reported
65 y.o./F10/2005/Lin et al. [20]Gastric corpusIncidental finding 1 . 1 × 0 . 7 × 0 . 3 Surgical(+) CD117/c-kit; (+) CD34; (+) NSE; (+) S-100Not reportedNoNo, 28 mos. after surgery
66 y.o./M8/2007/Efstathios et al. [21]Small bowelSmall bowel obstruction10 in diaSurgical(+) CD117/c-kit; (+) SMA, (+) S-100Spindle-shaped cells; 8–10/hpfYes (I)Yes, 2 years after treatment
60 y.o./F/NF-12010/Ohtake et al. [22]Multiple jejenum/duodenumIncidental finding1.4 dia.Surgical(+) CD117/c-kit; (+) CD34Spindle-shaped cells/<5/50/hpfNoNo, 2 years after surgery
34 y.o./F5/2009/Masoodi et al. [23]Transverse colonAbdominal lump8.0 in dia.Surgical/conventional chemotherapy(+) CD117/c-kit Spindle shaped/no mitotic activityNoNo, 8 months after treatment
75 y.o./M5/2008/Laperouse et al. [9]Body of stomachGI bleed 5 . 0 × 3 . 5 × 3 . 5 Surgery(+) CD117/c-kit; (+) CD34, (+) desminSpindle-shaped cells; <5/50/hpfYes (I)Not reported
68 y.o./M10/2004/Demetri et al. [7]Retroperitoneum contiguous with post. wall stomach, pancreas, multiple liver massIncidental finding13 in dia.Surgery(+) CD117/c-kit; (+) CD34Spindle-shaped cells/low mitotic rateYes (I) initially then (S)Not reported
54 y.o./M02/2010/Freeman et al. [24]Greater curvature of stomachUpper Abdominal pain1.3 on dia.Surgery(+) CD117/c-kit 10/hpfYes (I)No, 18 months after treatment
42 y.o./F4/2007/Pinto et al. [25]Small bowelLower abdominal pain4.8 in diaSurgery(+) CD117/c-kit; (+) CD34Spindle-shaped cell; 9/50 hpfYes (I)No, 16 months after treatment
76 y.o./F4/2007/Pinto et al. [25]StomachDysuria, altered bowel movement, abdominal discomfort17 in dia.Surgery(+) CD117/c-kit; (+) CD34Spindle-shaped cell; 7/50 hpf mitotic indexNoNo, 12 months after treatments
61 y.o./F6/2011/Fan et al. [26]RectumLower GI bleed8.0 in diaSurgery(+) CD117/c-kit; (+) CD34; (+) SMA5/50 hpf mitotic indexNoNot reported
17 y.o./M08/2009/Luo et al. [27]R liver lobeIncidental finding 5 . 1 × 3 . 8 × 4 . 6 Radiofrequency ablation(+) CD117/c-kit; (+) CD34; (+) vimentinSpindle cells/no mitosisNoNo, 3 mos. after treatment
28 y.o./M07/2010/Yucel et al. [28]DuodenumAbdominal pain24 in dia.Surgery(+) CD117/c-kit; (+) CD340/50 hpf mitotic indexNoNot reported
62 y.o./M07/2010/Yucel et al. [28]Fundus of stomachAbdominal pain10 in diaSurgery(+) CD117/c-kit; (+) CD34<5/50 hpf mitotic indexNoNot reported
38 y.o./M07/2010/Yucel et al. [28]JejunumAbdominal pain, rectal bleeding2.5 in dia.Surgery(+) CD117/c-kit; (+) CD34<1/50 hpf mitotic indexNoNot reported
62 y.o./M01/2009/Lee et al. [29]StomachSymptomatic anemiaNot reportedSurgery(+) CD117/c-kit Spindle-shaped cells; 60/50 hpfYes (I)Yes, Increase in tumor size, liver 2 years after therapy
80 y.o./M2011/Theodosopoulos et al. [30]StomachEpigastric discomfort, nausea, weight loss3.0 in dia.Surgery(+) CD117/c-kit Severe nuclear atypia; 6/50 hpf mitotic indexYes (I)No, 1 year after treatment
52 y.o./F12/2009/Ulusan et al. [31]Small intestineAbdominal pain 1 8 × 1 3 × 7 Surgery(+) CD117/c-kit; weakly (+) S-100, SMA, CD343/50 hpf mitotic indexYes (I)Not reported
31 y.o./F06/2003/Sakamoto et al. [32]Duodenum/pancreasNot mentionedNot reportedSurgery(+) CD117/c-kit Low-grade malignant potentialNoNot reported
28 y.o./F2010/Abdel-Ghaffar [33]MesenteryAbdominal pain, distention 2 0 × 1 8 × 1 6 Surgery(+) CD117/c-kit; (+) CD34Spindle-shaped cells with twisted nuclei; 7/50 hpfNoNo, 3 years after treatment
65 y.o./M06/2007/Todoroki et al. [34]Greater omentumAbdominal mass 2 0 × 1 7 × 6 Surgery(+) CD34; weakly (+) CD117/c-kit; PDGFA gene mutation on exon 12Mixed spindle-epitheloid; 2/50 hpfYesNo, 6 months after treatment
38 y.o./M06/2011/Dhull et al. [35]JejunumAbdominal pain/abdominal fullness 1 0 × 1 5 Surgery(+) CD117/c-kit Spindle-shaped cells; high grade stromal tumorYes (I)No, 6 months after therapy
65 y.o./F3/2008/Dickhoff et al. [36]RectumAbdominal pain15 in dia.Surgery(+) CD117/c-kit High mitotic rateNoYes, 1 year after
62 y.o./M3/2008/Dickhoff et al. [36]Rectum, metastaticObstipation, voiding problem 8 . 9 × 8 . 6 Imatinib(+) CD117/c-kit High mitotic rateN/ANo, regression of tumor on ff up
55 y.o./M/NF-111/2009/Takeuchi et al. [37]DuodenumIncidental finding 2 . 5 × 2 . 5 × 2 . 3 Surgery(+) CD117 c-kit/(+) CD34,Spindle-shaped cells; 3/50 hpfNoNo, after 2 years
56 y.o./F3/2010/Tahara et al. [38]Lesser curvature of gastric corpusAbdominal pain, nausea, anemia 1 . 8 × 1 . 5 × 1 . 0 Surgery(+) CD117 c-kit/(+) CD34Spindle-shaped cells; 0/50 hpfNoNo, after 18 mos.
66 y.o./F/NF-110/2010/Kitagawa et al. [39]JejunumPartial seizures6.0 in dia.Surgery(+) CD117/c-kit/wild type KITSpindle-shaped cells; 5/50 hpfNoNot reported
70 y.o./M/NF-15/2011/Takakura et al. [40]JejunumMelena, fatigue 2 . 8 × 2 . 4 × 1 . 8 Surgery(+) CD117/c-kit/(+) CD34Spindle-shaped cell; low mitotic activityNoNot reported
28 y.o./F2010/Varras et al. [41]Small intestineAbdominal pain 1 3 × 1 0 × 9 . 0 Surgery(+) CD117/c-kit/(+) CD34Mixed spindle-epithelioid; 5/50 hpfYes (I)No, 3 years after

Abbreviations: I—imatinib. S—sunitinib. hpf—high-power field. NF-1—neurofibromatosis type 1. SMA—smooth muscle actin. NSE—nonspecific enolase. PDGFRA—platelet-derived growth factor receptor alpha.