Teke Zafer, Rencuzogullari Ahmet, Yalav Orcun, Erdogan Osman, Gumus Serdar, Doran Figen
Ann Ital Chir. 2023;94:358-366.
Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract. Significant advances have been made in its pathogenesis, diagnosis, and treatment over the past few decades. However, little is known about the occurrence of synchronous or methacronous tumors with other histogenesis in addition to GISTs. The aim of this study was to present a series of 15 patients diagnosed with a second primary neoplasm in addition to GIST.
Patients who were diagnosed with both GIST and other primary neoplasm between January 2010 and December 2019 were included in the study. Demographic, clinicopathologic and immunohistochemical parameters of the patients were analyzed along with the follow-up results RESULTS: This study included 12 men and 3 women with a median age of 68 years (range: 57-83 years). Of the GISTs, 93.3% were localized in the stomach and 73.3% were at very low / low risk category. Of the second primary tumors, 66.6% were in the gastrointestinal tract. Detection of the GIST was synchronous in 9 cases, metachronous in 2 cases and preceded the GIST diagnosis in 4 cases. GIST was incidentally found intra-operatively in 3 of the cases. The mean size of the synchronous GISTs was 20 mm while the most common GIST-associated malignancy was gastric adenocarcinoma. The median follow-up times was 62 months (range: 13-129 months).
The prevalence of secondary malignancies in GIST patients is significantly higher than the healthy population. The high occurrence rate of additional primary tumors in GIST patients has focused the attention of surgeons on this problem. While it is not yet clear if there is a causal association or a common genetic mechanism for the concomitant occurrence of GIST with other malignancies, a closer surveillance of GIST patients is needed due to their proved increased prevalence of a second primary tumor especially during the first year after diagnosis.
Gastrointestinal stromal tumor, Coexistence, Synchronous malignancy, Second neoplasm, Gastric adenocarcinoma.
胃肠道间质瘤（GIST）是胃肠道最常见的原发性间叶性肿瘤。在过去几十年中，其发病机制、诊断和治疗取得了重大进展。然而，除GIST外，对于同时或异时发生的其他组织发生类型肿瘤的情况知之甚少。本研究的目的是报告15例除GIST外还诊断出第二种原发性肿瘤的患者。
纳入2010年1月至2019年12月期间诊断为GIST和其他原发性肿瘤的患者。分析患者的人口统计学、临床病理和免疫组化参数以及随访结果。结果：本研究包括12名男性和3名女性，中位年龄为68岁（范围：57 - 83岁）。在GIST中，93.3%位于胃，73.3%为极低/低风险类别。在第二种原发性肿瘤中，66.6%位于胃肠道。9例GIST的检测为同时性，2例为异时性，4例在GIST诊断之前。3例患者术中偶然发现GIST。同时性GIST的平均大小为20 mm，最常见的与GIST相关的恶性肿瘤是胃腺癌。中位随访时间为62个月（范围：13 - 129个月）。
GIST患者继发性恶性肿瘤的患病率显著高于健康人群。GIST患者中额外原发性肿瘤的高发生率已引起外科医生对该问题的关注。虽然尚不清楚GIST与其他恶性肿瘤同时发生是否存在因果关联或共同的遗传机制，但由于已证实GIST患者第二种原发性肿瘤的患病率增加，尤其是在诊断后的第一年，因此需要对GIST患者进行更密切的监测。
胃肠道间质瘤；共存；同时性恶性肿瘤；第二种肿瘤；胃腺癌
