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Gastrointestinal Stromal Tumors (Gists) : Surgical Management Update 2009
Gastrointestinal Stromal Tumors (Gists) : Surgical Management Update 2009
TUMORS (GISTS)
SURGICAL MANAGEMENT UPDATE
2009
Warko Karnadihardja
INTRODUCTION
GISTs are the commonest mesenchynal tumors in the GIT
Worldwide incidence + 15 per million
Steijfer S et al : Nat Clin Pract Oncol.2008.5; 102-111
Hirota et al (1998) investigated molecular biology :
A mutation in the juxtamembrane domain of CD117 (c-
kit) resulted in constitutive activation (gain-of-function)
of the c-kit receptor tyrosine kinase
This mutation is present in 90% of GISTs, and one-third of
GISTs lacking c-kit mutations have a mutation in a related
tyrosine kinase, platelet-derived growth factor receptor α
(PDGRFA)
Heinrich ML et al Science 2003, 299: 708-710
INTRODUCTION-2
Kindblom et al (1998) and Sircar et al (1999) GISTs
share a common percussor with the interstitial cells
of Cajal, which regulate autonomous gut
peristalsis and are intercalated between the
longitudinal and circular layer of muscularis
propria throughout the GIT
GISTs occur most commonly in the stomach (60%)
followed by : small intestine (25%), colon and
rectum (10%) and esophagus (5%)
TYROSINE KINASE INHIBITOR (TKI)