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      Current endoscopic ultrasound-guided approach to incidental subepithelial lesions: optimal or optional?


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          Subepithelial lesions (SEL) are identified during endoscopic procedures on a regular basis. They can occur anywhere in the gastrointestinal (GI) tract and are located beneath the normal epithelial layer, which explains why a tissue diagnosis is difficult to obtain with routine biopsies. Endoscopic ultrasound (EUS) is used to further characterize these lesions. EUS can distinguish intramural lesion from extramural compression. Furthermore, it allows allocation of intramural lesions to a specific layer of the GI wall and offers additional information as to whether a lesion could be benign or malignant. EUS also assists in choosing the optimal means of tissue acquisition. The choice of tissue acquisition is based on a number of factors, such as tumor size, EUS features, and location within the GI tract or within a specific layer of the GI wall. Furthermore, local expertise and patient factors should be considered when deciding whether tissue acquisition, surgical intervention or follow up is recommended. In this review we offer an EUS-guided approach to the evaluation of incidental SEL based on current evidence and point out areas of uncertainty, which explain why the proposed algorithmic approach may be optional rather than optimal.

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          NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines.

          The NCCN Soft Tissue Sarcoma Guidelines include a subsection about treatment recommendations for gastrointestinal stromal tumors (GISTs). The standard of practice rapidly changed after the introduction of effective molecularly targeted therapy (such as imatinib and sunitinib) for GIST. Because of these changes, NCCN organized a multidisciplinary panel composed of experts in the fields of medical oncology, molecular diagnostics, pathology, radiation oncology, and surgery to discuss the optimal approach for the care of patients with GIST at all stages of the disease. The GIST Task Force is composed of NCCN faculty and other key experts from the United States, Europe, and Australia. The Task Force met for the first time in October 2003 and again in December 2006 with the purpose of expanding on the existing NCCN guidelines for gastrointestinal sarcomas and identifying areas of future research to optimize our understanding and treatment of GIST.
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            ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Colorectal Neuroendocrine Neoplasms

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              High incidence of microscopic gastrointestinal stromal tumors in the stomach.

              Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms with an annual incidence of approximately 10 to 20 per 1 million cases. Although pathologists have often observed incidental small GISTs in the stomach resected from patients with gastric cancer, no report on the real incidence of gastric GISTs is available. In this study, 100 whole stomachs resected from patients with gastric cancer were sectioned at 5-mm intervals and hematoxylin and eosin-stained slides (a mean of 130 slides for each case) were examined for microscopic GISTs. KIT (CD117), CD34, and desmin expression of the incidental tumors was evaluated by immunohistochemistry, and genomic DNA extracted from formalin-fixed and paraffin-embedded tumor tissues was analyzed for c-kit gene mutations in exon 11. In 35 of the 100 whole stomachs, we found 50 microscopic GISTs, all of which were positive for KIT and/or CD34 and negative for desmin. Most microscopic GISTs (45/50, 90%) were located in the upper stomach. Two of the 25 (8%) microscopic GISTs had c-kit gene mutations. Fifty-one leiomyomas with positive expression for desmin were observed in 28 of the 100 stomachs. Both leiomyomas and GISTs were found in 12 stomachs. These results indicate that microscopic GISTs are common in the upper portion of the stomach. Considering the annual incidence of clinical GISTs, only few microscopic GISTs may grow into a clinical size with malignant potential. Further studies are required to clarify the genetic events responsible for the transformation of microscopic GISTs to clinical GISTs.

                Author and article information

                Ann Gastroenterol
                Ann Gastroenterol
                Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology
                Hellenic Society of Gastroenterology (Greece )
                Apr-Jun 2015
                : 28
                : 2
                : 160-172
                [a ]Department of Gastroenterology and Hepatology, DKD Helios Klinik Wiesbaden (Alexander J. Eckardt), Germany
                [b ]Department of Internal Medicine - Gastroenterology, Krankenhaus Märkisch Oderland, Strausberg-Wriezen (Christian Jenssen), Germany
                Author notes
                Correspondence to: Alexander J. Eckardt, MD, Department of Gastroenterology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191 Wiesbaden, Germany, Tel.: +11 49 611 577 450, Fax: +11 49 611 577 460, e-mail: alexander.eckardt@ 123456dkd-wiesbaden.de ; alexander.eckardt@ 123456helios-kliniken.de
                Copyright: © Hellenic Society of Gastroenterology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 14 October 2014
                : 10 November 2014
                Invited Review

                endoscopic ultrasonography,fine needle aspiration,subepithelial lesions,gastrointestinal stromal tumor


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