Background: Mesenchymal tumors are part of a heterogeneous group of neoplasms.
Objectives: The present study investigated the clinicopathological properties and surgical outcomes of patients with gastric mesenchymal tumors who underwent surgical treatment.
Methods: This study included all cases who underwent surgical treatment for mesenchymal tumors in Başakşehir Çam and Sakura City Hospital, Turkey, between August 2020 and August 2022. The demographic data and clinical properties of the patients, operative details, postoperative assessments, pathological specifications of the tumor, and immunohistochemical analysis results were evaluated.
Results: The study included 14 patients, 57% of whom were male. Patients had a mean age of 59.7±9.3 years. The most frequent American Society of Anesthesiologists (ASA) score was ASA 2 in 10 (72%) patients, and the mean hemoglobin level was 12±1.9 g/dl. All patients underwent wedge resection, 5 (35.7%) by a minimally invasive method. The mean duration of operation was 98.9±29.4 min. There were no intraoperative complications, conversions, or postoperative mortalities, and the mean duration of hospital stay was 6.2±3.2 days. One patient made an unplanned re-admission to the hospital due to inadequate oral intake. As an adjuvant treatment, three patients were prescribed imatinib. The tumor location was most frequently the corpus in 5 (36%) patients, and the mean tumor diameter was 62±35.2 mm. Stromal tumors were the most common histological type in 10 (72%) patients, and the other histological types were leiomyoma in 3 (21%) and pancreatoblastoma in 1 (7%) patient. The median and maximum Ki-67 index were 3 and 80, respectively, and the median and maximum mitotic index were 3 and 18, respectively. The number of dissected lymph nodes was nine in one patient and five in another. The surgical margin was positive in one patient, and no patient had a perforated tumor.
Conclusion: Among the different types of mesenchymal tumors of the gastrointestinal system, which are rare, stromal tumors are the most common histological type. Gastric mesenchymal tumors can be safely treated with wedge resection, an approach that is associated with low postoperative morbidity and mortality.
Sbaraglia M, Businello G, Bellan E, Fassan M, Dei Tos AP. Mesenchymal tumours of the gastrointestinal tract. Pathologica. 2021;113(3):230-51. doi: 10.32074/1591-951X-309. [PubMed: 34294940].
Doyle LA, Hornick JL. Mesenchymal tumors of the gastrointestinal tract other than GIST. Surg Pathol Clin. 2013;6(3):425-73. doi: 10.1016/j.path.2013.05.003. [PubMed: 26839096].
Do IG, Jung KU, Koo DH, Lee YG, Oh S, Kim K, et al. Clinicopathological characteristics and outcomes of gastrointestinal stromal tumors with high progranulin expression. PloS One. 2021;16(1):e0245153. doi: 10.1371/journal.pone.0245153. [PubMed: 33411849].
Hwang SH, Jung M, Jeong YH, Jo K, Kim S, Wang J, et al. Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with localized primary gastrointestinal stromal tumors. Cancer Metab. 2021;9(1):1-9. doi: 10.1186/s40170-021-00244-x. [PubMed: 33509304].
Nomenjanahary L, Rabarison MR, Razafimahefa VJ, Randrianjafisamindrakotroka NS. Mesenchymal tumors in gastrointestinal tract. Open J Pathol. 2022;12(4):171-6. doı: 10.4236/ojpathology.2022.124020.
Uzunoglu H, Tosun Y, Akinci O, Baris B. Gastrointestinal stromal tumors of the stomach: A 10-year experience of a single-center. Niger J Clin Pract. 2021;24(12):1785-92. doi: 10.4103/njcp.njcp_558_20. [PubMed: 34889786].
Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg. 2004;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. [PubMed: 15273542].
Von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM, Casper ES, et al. Gastrointestinal stromal tumors, version 2.2014. J Natl Compr Canc Netw. 2014;12(6):853-62. doi: 10.6004/jnccn.2014.0080. [PubMed: 24925196].
Giuliano K, Ejaz A, Reames BN, Choi W, Sham J, Gage M, et al. Comparing the long‐term outcomes among patients with stomach and small intestine gastrointestinal stromal tumors: an analysis of the National Cancer Database. J Surg
Oncol. 2018;118(3):486-92. doi: 10.1002/jso.25172. [PubMed: 30129672].
Bard V, Menasherov N, Morgenstern S, Haddad R, Kashtan H. Gastrointestinal stromal tumor of stomach: a gentle enemy of the surgeon. Our experience in confronting the disease. Surgl Laparosc Endosc Percutan Tech. 2016;26(5):406-9. doi: 10.1097/SLE.0000000000000317. [PubMed: 27661206].
Wang M, Xu J, Zhang Y, Tu L, Qiu WQ, Wang CJ, et al. Gastrointestinal stromal tumor: 15-years’ experience in a single center. BMC Surgery. 2014;14(1):1-10. doi: 10.1186/1471-2482-14-93.
Erdogan O, Parlakgumus A, Topal U, Yener K, Tas ZA, Irkorucu O. Clinicopathological characteristics and prognostic factors of gastrointestinal stromal tumors treated with curative surgery. Ann Clin Anal Med. 2022;13(8):854-59
Casali PG, Abecassis N, Bauer S, Biagini R, Bielack S, Bonvalot S, et al. Gastrointestinal stromal tumours: ESMO–EURACAN Clinical Practice Guidelines for diagnosis, treatment
and follow-up. Ann Oncol. 2018;29(4):68-78. doi: 10.1093/annonc/mdy095. [PubMed: 29846513].
Keung EZ, Raut CP. Management of gastrointestinal stromal tumors. Surg Clin North Am. 2017;97(2):437-52. doi: 10.1016/j.suc.2016.12.001. [PubMed: 28325196].
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum pathol. 2002;33(5):459-65. doi: 10.1053/hupa.2002.123545. [PubMed: 12094370].
Nishida T, Goto O, Raut CP, Yahagi N. Diagnostic and treatment strategy for small gastrointestinal stromal tumors. Cancer. 2016;122(20):3110-8. doi: 10.1002/cncr.30239. [PubMed: 27478963].
El-Menyar A, Mekkodathil A, Al-Thani H. Diagnosis and management of gastrointestinal stromal tumors: An up-to-date literature review. J Cancer Res and Ther. 2017;13(6):889-900. doi: 10.4103/0973-1482.177499. [PubMed: 29237949].
Elagöz Ş, Arıcı S, Karakaya EA, Özer H, Turan M. Evaluation of histopathologic and immunohistochemical features of gastrointestinal stromal tumors. Turk J Surg. 2006;22(1):7-12.
Kang HC, Menias CO, Gaballah AH, Shroff S, Taggart MW, Garg N, et al. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics. 2013;33(6):1673-90. doi: 10.1148/rg.336135507. [PubMed: 24108557].
ESMO. Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23:49-55. doi: 10.1093/annonc/mds252. [PubMed: 22997454].
Von Mehren M, Benjamin RS, Bui MM, Casper ES, Conrad EU, DeLaney TF, et al. Soft tissue sarcoma, version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012;10(8):951-60. doi: 10.6004/jnccn.2012.0099. [PubMed: 22878820].