Agaimy Abbas, Vassos Nikolaos, Wunsch Peter H, Hohenberger Werner, Hartmann Arndt, Croner Roland S
Institute of Pathology, University Hospital, Erlangen, Germany.
Int J Clin Exp Pathol. 2012;5(1):12-22. Epub 2012 Jan 1.
Peritoneal and hepatic metastases are the main routes of spread of gastrointestinal stromal tumors (GIST). However, criteria to predict the site and pattern of recurrence in individual cases are still lacking.
We retrospectively analyzed 67 consecutive GISTs with complete gross descriptions to correlate macroscopic patterns with clinical course. Primary endpoint was the appearance of synchronous or metachronous peritoneal disease. Tumors were classified into type I (luminal/intramural) and type II (extramural) based on the macroscopic/histologic presence or absence of normal tissue between deeper tumor border and serosa, respectively.
Patients were 35 men and 32 women (mean age, 64 yrs) with gastric (n=32), small bowel (n=30) and large bowel (n=5) GISTs. Based on the above proposal, 22 tumors were classified as type I and 45 as type II. Type I tumors were predominantly gastric (18/22; P<0.001) and frequently had very low/low risk (14/22; P<0.001) whereas type II tumors were predominantly intestinal (31/45; P<0.001) and often of intermediate/high risk (36/45; P<0.001). Ten patients had synchronous peritoneal spread and 6/30 patients with a mean follow-up of 29 months developed metachronous peritoneal spread at a mean of 27 months. Tumor rupture was seen in 2 patients (3%). Thus, 16/40 patients (40%) had synchronous or metachronous peritoneal progression. Taken by gross type, peritoneal progression was seen in 15/30 type II compared to 1/10 type I tumors (p=0.032).
this study points to extramural growth as a predictor of peritoneal recurrence in GIST, probably as a consequence of tumor rupture or due to microscopic serosal penetration. This study aimed at alerting surgical pathologists to the importance of careful gross and microscopic assessment of resection specimen harboring GIST to allow for reliable prospective evaluation of serosal involvement as an adverse prognostic factor in GIST.
腹膜和肝转移是胃肠道间质瘤（GIST）的主要扩散途径。然而，预测个体病例复发部位和模式的标准仍然缺乏。
我们回顾性分析了67例具有完整大体描述的连续性GIST，以将宏观模式与临床病程相关联。主要终点是同时性或异时性腹膜疾病的出现。根据肿瘤深部边界与浆膜之间正常组织的宏观/组织学存在与否，肿瘤分为I型（腔内/壁内）和II型（壁外）。
患者包括35名男性和32名女性（平均年龄64岁），患有胃GIST（n = 32）、小肠GIST（n = 30）和大肠GIST（n = 5）。根据上述提议，22个肿瘤被分类为I型，45个为II型。I型肿瘤主要为胃GIST（18/22；P < 0.001），且通常具有极低/低风险（14/22；P < 0.001），而II型肿瘤主要为肠道GIST（31/45；P < 0.001），且常为中/高风险（36/45；P < 0.001）。10例患者有同时性腹膜扩散，30例平均随访29个月的患者中有6例在平均27个月时出现异时性腹膜扩散。2例患者（3%）出现肿瘤破裂。因此，40例患者中有16例（40%）有同时性或异时性腹膜进展。按大体类型来看，15/30例II型肿瘤出现腹膜进展，而I型肿瘤仅1/10例出现（p = 0.032）。
本研究指出壁外生长是GIST腹膜复发的一个预测因素，可能是肿瘤破裂或显微镜下浆膜侵犯的结果。本研究旨在提醒外科病理学家，对含有GIST的切除标本进行仔细的大体和显微镜评估非常重要，以便可靠地前瞻性评估浆膜受累作为GIST不良预后因素的情况。
