Tumor estromal gastrointestinal: análise de fatores relacionados ao prognóstico

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Abstract

OBJETIVO: estudar os critérios morfológicos e imunoistoquímicos relacionados ao prognóstico dos tumores estromais gastrointestinais. MÉTODOS: o estudo foi retrospectivo de 42 casos de tumor estromal gastrointestinal (GIST). Vinte e cinco casos foram obtidos no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Gaffrée e Guinle e os outros dezessete, do Serviço de Anatomia Patológica do Hospital Universitário Clementino Fraga Filho. RESULTADOS: de acordo com a análise univariada os tumores maiores que 5 cm, com número de mitoses maior que 5/50 CGA, presença de necrose, de alto risco, revelaram significância em relação a redução da sobrevida (p= 0,017, 0,010, 0,001 e 0,016, respectivamente). Os outros fatores analisados (subtipo histológico, topografia e imunofenótipo) não mostraram significância. CONCLUSÃO: os resultados confirmam a utilidade do grau de risco, do tamanho tumoral, do índice mitótico e da necrose como fatores preditores do comportamento biológico dos tumores estromais gastrointestinais.

Translated abstract

OBJECTIVE: study the morphologic criteria and immunohistochemical related with the prognostic of the gastrointestinal stromal tumors. METHODS: the study was retrospective of 42 cases of gastrointestinal stromal tumor (GIST). Twenty-five cases were obtained in the file of the Services of Pathological Anatomy of the Hospital Gaffrée and Guinle and the other 17 of Pathological Anatomy of the Hospital Clementino Fraga Filho. RESULTS: in agreement with the univaried analysis, the tumors largest than 5 cm, with mitoses number greater than 5/50 CGA, presence of necrosis, high risk, revealed significance with regarding the reduction of the survival (P = 0.017, 0.01, 0.001 and 0.016, respectively). The other analyzed factors (histological subtype, topography and imunophenotype) they didn't show significance. CONCLUSION: the results confirm the usefulness of the risk degree, the tumorous size, the mitotic index and the necrosis as predictor factors of the biological behavior of the gastrointestinal stromal tumors.

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Most cited references 42

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Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT).

M Sarlomo-Rikala, M Miettinen, L Sobin (2000)

Gastrointestinal (GI) stromal tumor (GIST) is the designation for the major subset of GI mesenchymal tumors and encompasses most tumors previously classified as GI smooth muscle tumors. Although GISTs typically express CD117 (KIT), often express CD34, and sometimes express alpha-smooth muscle actin (SMA), the relative frequency of these markers has not been characterized in large series of GISTs of different sites, and the CD117 expression has not been fully characterized in intra-abdominal tumors. In this study, we immunohistochemically analyzed 292 GISTs throughout the GI tract, including omentum and mesentery, and compared the immunoreactivities with 211 other tumors that may enter in the differential diagnosis. GISTs were defined in this study as CD117-positive primary spindied or epithelioid mesenchymal tumors of the GI tract, omentum, or mesentery. The CD34 positivity of GISTs varied from 47% in small bowel to 96 to 100% in rectum and esophagus, whereas SMA expression showed the opposite patterns and was most frequent in the GISTs of small bowel (47%) and rarest in the GISTs of rectum and esophagus (10-13%). Desmin was seen only occasionally. S100 positivity was rare but was seen most frequently in small intestinal GISTs (15%). True leiomyomas from esophagus, muscularis mucosae of colorectum, and pericolic leiomyomas similar to uterine leiomyomas were negative for CD117 and CD34 and positive for SMA and desmin (46 of 46). Inflammatory fibroid polyps of stomach and small intestine were negative for CD117 but were often positive for CD34 (6 of 8) and variable for SMA (3 of 8). Inflammatory myofibroblastic tumors involving gastric or colonic wall were negative for CD117 but some showed CD117-positive endothelia. GI schwannomas were all negative for CD117 and positive for S100 protein (11 of 11). Extremely focal CD117 positivity was seen in the neoplastic cells of some retroperitoneal leiomyosarcomas and liposarcomas. Among other CD117-positive tumors were intestinal metastatic melanomas (8 of 11) and extraskeletal Ewing's sarcomas (5 of 11), two of which were abdominal. In conclusion, strong CD117 expression defines most primary GI mesenchymal tumors as GISTs, which show different patterns for CD34 and SMA in various parts of the GI tract. Some unrelated CD117-positive tumors (melanomas, Ewing's sarcomas) should not be confused with GISTs.

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Prognostic significance of expressions of cell-cycle regulatory proteins in gastrointestinal stromal tumor and the relevance of the risk grade.

Takashi Yao, Masazumi Tsuneyoshi, Norimoto Nakamura … (2005)

Gastrointestinal stromal tumors (GISTs) have a wide spectrum of biologic behavior ranging from benign to malignant. Risk grading based on tumor size and mitotic counts has been proposed in an effort to predict the adverse outcome of GIST in the literature so far. Recent molecular studies have reported the prognostic values of several parameters, including alteration of cell-cycle regulators. The aim of this study was to elucidate the prognostic values of risk grade and alterations of cell-cycle-related proteins, including Ki-67, cyclin A, cyclin B1, cyclin D1, cyclin E, p16, p21, p27, p53, cdc2, and cdk2, in addition to the conventional factors. Eighty cases of primary c-kit-positive GISTs were classified into 2 cases of very-low-risk grade, 20 cases of low-risk grade, 25 cases of intermediate-risk grade, and 33 cases of high-risk grade. The risk grade was correlated with the presence of metastases and/or recurrence. A high level of Ki-67 and cyclin A expression was correlated with risk grade (P = .0027 and .0441, respectively). Overexpression of G2-M regulators, such as cyclin A, cyclin B1, and cdc2, was associated with the Ki-67 labeling index (LI) (P = .0007, .0475, and .0040, respectively). According to univariate analysis, tumor grade (high risk), tumor size (> or =5 cm), mitotic counts (> or =5/50 high-power fields), Ki-67 LI (> or =4.92%), cyclin A LI (> or =1.61%), and cdc2 LI (> or =1.25%) were all found to be significantly associated with a shorter period of disease-free survival (P = .0001, .0270, .0004, .0001, .0001, and .0011, respectively). According to multivariate analysis, both high Ki-67 LI and high-risk grade were found to be significantly associated with a shorter period of disease-free survival (P = .0083 and .0246, respectively). In conclusion, our results strongly support the hypothesis that Ki-67 LI and risk grade are useful for predicting the aggressive biologic behavior of GISTs. Furthermore, alteration of G2-M regulators, such as cyclin A, cyclin B1, and cdc2, is also a useful marker for predicting aggressive behavior and play an important role, at least in part, in the cell proliferation of GIST.

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Smooth muscle tumors of the gastrointestinal tract. A study of 56 cases followed for a minimum of 10 years.

H. Evans (1985)

Cases of gastrointestinal smooth muscle tumor seen at M. D. Anderson Hospital and followed for a minimum of 10 years are presented. The tumors were classified as high-grade leiomyosarcoma (41 cases), low-grade leiomyosarcoma (13 cases), and leiomyoma (2 cases). All of the leiomyosarcomas originated in the stomach (21 cases), small intestine (29 cases), or rectum (4 cases) and appeared to have arisen from the muscularis propria. Leiomyosarcomas were considered high-grade when the maximal mitotic rate in ten consecutive high-power fields was ten or more and low-grade when this rate was lower (actual maximal rates in the low-grade group varied from 1-5/10 high-power fields). All patients with high-grade leiomyosarcoma died of tumor after intervals ranging from 5 to 90 months (median, 25 months). All but two with low-grade leiomyosarcoma also died of tumor, but frequently after much longer intervals (range, 42-221 months; median, 98 months; survival difference P = 0.002). Intervals to recurrence and metastasis were correspondingly longer in the low-grade group (up to 188 months). The two leiomyomas were small (less than 2 cm), had no mitotic figures, and were less cellular than any of the leiomyosarcomas. However, they both occurred in locations in which no leiomyosarcomas were seen (muscularis propria of the esophagus and muscularis mucosae of the rectum); therefore, the problem of distinguishing leiomyomas from leiomyosarcomas in sites where the latter did arise could not be resolved, particularly in view of the fact that fatal low-grade leiomyosarcomas had diameters as small as 1 cm and maximal mitotic rates as low as one per ten high-power fields. "Leiomyoblastoma" was not found to be an entity; it is recommended that this term be dropped.

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Author and article information

Contributors

Rodrigo Panno Basilio de Oliveira: Role: ND

Vera Lucia Pannain: Role: ND

Pedro Eder Portari Filho: Role: ND

Alemar Roge Salomão: Role: ND

Antonio Carlos Iglesias: Role: ND

Carlos Alberto Basilio de Oliveira: Role: ND

Journal

Journal ID (publisher): rcbc

Title: Revista do Colégio Brasileiro de Cirurgiões

Abbreviated Title: Rev. Col. Bras. Cir.

Publisher: Colégio Brasileiro de Cirurgiões (Rio de Janeiro )

ISSN: 1809-4546

Publication date (Print): December 2007

Volume: 34

Issue: 6

Pages: 374-380

Affiliations

[1 ] Universidade Federal do Estado do Rio de Janeiro Brazil

[2 ] Universidade Federal do Rio de Janeiro Brazil

[3 ] Universidade Federal do Rio de Janeiro Brazil

[4 ] Universidade Federal do Estado do Rio de Janeiro Brazil

[5 ] Instituto Nacional do Câncer

[6 ] Universidade Federal do Estado do Rio de Janeiro Brazil

[7 ] Universidade Federal do Estado do Rio de Janeiro Brazil

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Publisher ID: S0100-69912007000600004

DOI: 10.1590/S0100-69912007000600004

SO-VID: 16f30301-1e0c-42d7-a7b2-5c59f2accbec

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http://creativecommons.org/licenses/by/4.0/

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Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-6991&lng=en

Tumor estromal gastrointestinal: análise de fatores relacionados ao prognóstico Translated title: Gastrointesinal stromal tumor: analysis of factors related to the prognostic

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Most cited references 42

Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT).

Prognostic significance of expressions of cell-cycle regulatory proteins in gastrointestinal stromal tumor and the relevance of the risk grade.

Smooth muscle tumors of the gastrointestinal tract. A study of 56 cases followed for a minimum of 10 years.

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