CASE REPORT

SESSION

GASTROINTESTINAL
STROMAL TUMOR
Benny Kurniawan
G1 A219011

Pembimbing :
dr. M. Rizal Syafe’i, Sp.B-KBD

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 ANATOMY

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Mckinley, M.P., O’loughin V.D., 2012. Human Anatomy. 3 edition. New York: McGraw-Hill Higher Education ; 780, 787.
rd
HISTOLOGY of Esophagus

Mckinley, M.P., O’loughin V.D., 2012. Human Anatomy. 3rd 3

edition. New York: McGraw-Hill Higher Education ; 791
HISTOLOGY of Gaster

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Mckinley, M.P., O’loughin V.D., 2012. Human Anatomy. 3rd edition. New York: McGraw-Hill Higher Education ; 795
HISTOLOGY of Small Intestine

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Mckinley, M.P., O’loughin V.D., 2012. Human Anatomy. 3rd edition. New York: McGraw-Hill Higher Education ; 798
HISTOLOGY of Large Intestine

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Mckinley, M.P., O’loughin V.D., 2012. Human Anatomy. 3rd edition. New York: McGraw-Hill Higher Education ; 801
 GASTROINTESTINAL STROMAL
TUMOR (GIST)
 GISTs  rare tumours, (1 per 100.000 per year), associated with high rates of
malignant transformation1,2

 These tumors share phenotypic similarities with the intestinal pacemaker cells
known as the interstitial cells of Cajal.3

 Interstitial cells of Cajal and GIST cells  the hematopoietic progenitor cell
marker CD34 and the growth factor receptor c-Kit. 3

 Expression of the c-Kit gene protein product, CD117,  stimulates the tumor
growth.3

1. Casali, P., et al. 2018. Gastrointestinal stromal tumours: ESMO–EURACAN Clinical Practice Guidelines for diagnosis,
treatment and follow-up. Annals of Oncology 2018; 29 (4): iv71
2. Parab, T., et al., ., 2019. Gastrointestinal Stromal Tumor : a comprehensive review. J Gastrointest Oncol 7
2019;10(1):144
 EPIDEMIOLOGY
1% to 2% of gastrointestinal neoplasms

The highest incidence rates (19–22 per million per year) 

Hong Kong, Shanghai, Taiwan, and Norway.

Stomach (56%) The lowest incidence  Shanxi province of China with 4.3
per million per year.
Small Intestine (32 %)
Median age  65 years
Colon and rectum (6 %)
Male : Female ratio = 1 : 1

Esophagus (0,7%)
10% to 30% of GISTs progress to malignancy
Other locations (5,5%)
GISTs occurring outside of the stomach are associated with
a higher malignant potential

Exophytic growth is noted in 79% of GISTs while intraluminal

or mixed growth occurs less frequently

Parab, T., et al., ., 2019. Gastrointestinal Stromal Tumor : a comprehensive review. J Gastrointest Oncol 2019;10(1):145 8
 Clinical Presentation

 Asymptomatic (18%)
 Nausea, vomiting
 Abdominal distention
 Early satiety
 Abdominal Pain
 Dysphagia
 Constipation
 Peritonitis  perforated neoplasm
 Gastrointestinal bleeding

 depending on the location of the mass

Parab, T., et al., ., 2019. Gastrointestinal Stromal Tumor : a comprehensive review. J Gastrointest Oncol 2019;10(1):145 9
 Additional Work-Up

Immunohisto-
Radiologic Histophatologic chemistry
• Abdominal USG
• CT-Scan, CT- • Spindel cell (70%) • Stained Positive
enterografi • Epiteloid cell (20%)
• MRI (Magnetic • Mixed (10%) for CD-117 and/or
Resonance Imaging) DOG-1
• PET Scans
• Endoskopic
UltraSound (EUS)

1. Parab, T., et al., ., 2019. Gastrointestinal Stromal Tumor : a comprehensive review. J Gastrointest Oncol 2019;10(1):145-147
2. Casali, P., et al. 2018. Gastrointestinal stromal tumours: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment
and follow-up. Annals of Oncology 2018; 29 (4): iv69
1
1
Figure 6 Microscopic Photo, H&E stain. (A) 40x objective magnification image of a GIST
spindle cell type; (B) 100x objective magnification image of a GIST epithelioid type.
Figure 5 CT with oral contrast showing a mass compressing the
mid-jejunal lumen with perforation

Figure 8 Microscopic photo. (A) 40x objective

magnification of GIST tat stains CD117 positive;
(B) 40x objective magnification of GIST that stains 1
DOG-1 positive 2
Abdominal ultrasound imaging :
A well-defined solid mass lesion with central cystic areas is noted posterior
to stomach, anterior to pancreas. Approximate size - 85 x 70 x 70 mm
Chu CS. Gastrointestinal stromal tumors: How to increase the preoperative endoscopic ultrasonography diagnostic
rate. J Med Ultrasound 2018;26:178
Figure 4 Contrast-enhanced CT in a
60-year-old male with GIST/ Contrast-
enhanced CT in the portal phase
depicts a small intraluminal
submucosal mass with sharply defined
margins and homogeneous contrast
enhancement in the stomach (arrow)

Figure 5 Contrast-enhanced CT in a
72-year-old female with GIST.
Contrast enhanced CT in the portal
venous phase depicts an
intraluminal submucosal mass with
a sharply defined margin, but
inhomogeneous contrast
enhancement in the stomach
(arrow).
Vernuccio, F., et al., 2016. Imaging of Gastrointestinal Stromal Tumors: From Diagnosis to Evaluation of Therapeutic
Response. Italy. ANTICANCER RESEARCH (36): 2643
Figure 7. T2-Weighted fast spin-echo magnetic
resonance imaging (T2-w FSE MRI) in a 57-year-old
female with jejunal GIST and liver metastasis. A: T2-w
FSE MRI shows a moderately hyperintense metastasis
in the fifth segment (arrow). After 5 months of imatinib
therapy, T2-w FSE MRI shows lesion enlargement
(arrow) with markedly hyperintense areas of cystic
change (B) and T1-w gradient echo image in the portal
phase after intravenous injection of gadolinium well
depicts peripheral areas of contrast enhancement due
to viable tumoral tissue (arrowhead) and central area of
cystic change (asterisk) (C)
((a), (b)) PET image showing localized increased
activity in association with large peritoneal GIST.
 STAGING

Solanki, R., et al., 2017. Gastrointestinal

Stromal Tumor : Three Decades
Lessons. International Journal Of
Current Medical And Pharmaceutical
Research, Vol. 3 : 1453
 STAGING

Solanki, R., et al., 2017. Gastrointestinal Stromal Tumor : Three Decades Lessons. International
Journal Of Current Medical And Pharmaceutical Research, Vol. 3 : 1454 20
STAGING

Parab, T., et al., ., 2019. Gastrointestinal Stromal Tumor : a

comprehensive review. J Gastrointest Oncol
2019;10(1):145-147 21
 GIST-1

National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn. 22
 GIST-2

National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn. 23
 GIST-3

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National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn.
 GIST-4

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National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn.
 GIST-5

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National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn.
 GIST-D

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National Comprehensive Cancer Network (NCCN). 2020. NCCN Guidelines For Soft Tissue Sarcoma 2020. Fort Washington, PA: nccn.
CONCLUSIONS
 GISTs that occur outside the stomach are associated with a higher malignancy
potential

 Usually GISTs are an incidental finding (asymptomatic)

 GISTs are best identified by CT scan

 Phatology  spindle cells, epithelioid cells, or mixed cell type

 Immunohistochemistry  stain positive for CD117 and DOG-1.

 Staging  TNM system

 Treatment  surgical resection + adjuvant

 Metastasis  liver and mesentery and omentum

Thank you