Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, United States.
World J Gastroenterol. 2021 Nov 7;27(41):7125-7133. doi: 10.3748/wjg.v27.i41.7125.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract and are thought to arise from precursors of the interstitial cells of Cajal. GISTs can arise anywhere in the GI tract, but most commonly originate from the stomach and small intestine. The majority of GISTs occur as a result of activating mutations in two receptor protein tyrosine kinases: KIT and/or platelet-derived growth factor receptor-α. Mutational analyses allow for predicting patient prognosis and treatment response. Clinical presentations can vary from no symptoms, typical in the case of small incidentally found tumors, to GI bleeding, abdominal discomfort, and ulcer-related symptoms when the tumor is enlarged. Imaging plays a critical role in the diagnosis and management of these tumors with multiphasic computed tomography serving as the imaging modality of choice. Magnetic resonance imaging and positron emission tomography-computed tomography can serve as imaging adjuncts in lesion characterization, especially with liver metastases, and subsequent staging and assessment for treatment response or recurrence. Surgical resection is the preferred management for small GISTs, while tyrosine kinase inhibitors - imatinib mesylate and sunitinib malate - serve as crucial molecular-targeted therapies for locally advanced and metastatic GISTs. This review article highlights the clinical presentation, pathology and molecular cytogenetics, imaging features, and current management of GISTs.
胃肠道间质瘤(GISTs)是胃肠道(GI)最常见的间叶性肿瘤,被认为起源于 Cajal 间质细胞的前体细胞。GISTs 可发生在胃肠道的任何部位,但最常见于胃和小肠。大多数 GISTs 是由于两种受体蛋白酪氨酸激酶的激活突变引起的:KIT 和/或血小板衍生生长因子受体-α。突变分析可预测患者的预后和治疗反应。临床表现从无症状(通常是偶然发现的小肿瘤)到胃肠道出血、腹部不适和肿瘤增大时与溃疡相关的症状不等。影像学在这些肿瘤的诊断和管理中起着关键作用,多期 CT 是首选的影像学方式。磁共振成像和正电子发射断层扫描-CT 可作为病变特征的影像学辅助手段,特别是在肝转移和随后的分期以及治疗反应或复发评估方面。手术切除是小 GISTs 的首选治疗方法,而酪氨酸激酶抑制剂-甲磺酸伊马替尼和苹果酸舒尼替尼-则是局部晚期和转移性 GISTs 的重要分子靶向治疗药物。本文综述了 GISTs 的临床表现、病理学和分子细胞遗传学、影像学特征以及当前的治疗管理。