cagas11 - Gastrointestinal Stromal Tumors Aruna Kommareddy,...

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Gastrointestinal Stromal Tumors Aruna Kommareddy, M.D. Fellow, Hematology/Oncology Washington University School of Medicine
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Case Presentation: History 58 year old male with H/O DM, HTN Symptoms of fatigue, SOB with activity and dysphagia more to solids in Oct 2000. Was found to be anemic. Referred to GI Endoscopy on 11/11 00 revealed an esophageal ulcer
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Pathology Biopsy revealed GIST Strong positive for C-kit and CD 34 No mitotic activity Ulceration could imply malignant behavior, but limited specimen
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Radiology CT chest and abdomen 11/11/00 :Thickening distal third of esophagus and small nodes in peri-esophageal space PET scan 11/16/00: Moderately increased uptake in distal esophagus, otherwise normal
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Pathology Esophagectomy in Dec 2000 Gross: Mass 6.5x5.5x3.5 cm mass at the GE junction with an ulcer 1.3 cm on the mucosal surface Microscopy: Spindle cell tumor, mitosis 5-25 per 10 HPF Tumor involved esophagus and stomach Negative nodes-4/4 Based on size, mitotic count and mucosal invasion-malignant GIST
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History Did well until June 02 Experienced weight loss EGD/biopsy – Gastric polyps, No GIST CT scan 8/02: Chest: Extensive mediastinal mass from the level of the aortic arch to lower chest, displacing trachea, bronchi and compressing left atrium, pericardial effusion Abdomen: Diffuse intraabdominal metastases, lymphadenopathy, LUQ mass 12.7x6.0 cm, liver mass 3x4cm
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History Early Sept 02: Orthostatic admitted to ICU for monitoring and R/O tamponade Echo: moderate pericardial effusion, no tamponade Esophagoscopy, broncoscopy and biopsy- Atypical cells.?Mucinous neoplasm. No evidence of GIST Biopsy of liver mass 9/02 : GIST Was seen in ICU by Medical oncology….
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GIST Gastro Intestinal Stromal Tumors Around 5,000 to 6,000 new cases each year Tends to occur in middle aged persons with a slight male predilection Occur throughout the GI tract
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Distribution Stomach 50-60% Small bowel 20-30% Large bowel 10% Esophagus 5% Else where in abdomen 5%
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Symptoms Symptoms depend on the site and size of the tumor Include: Abdominal pain Dysphagia Gastrointestinal bleeding Symptoms of bowel obstruction Small tumors may be asymptomatic
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Diagnosis Light microscopy in conjunction with Immuno-histochemistry
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Light microscopy Spindle Epitheliod Mixed Human pathology, Vol 33, May 2002
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Immunohistochemistry Positive staining for CD117, a cell surface antigen on the extracellular domain of the KIT receptor Positivity alone without a typical morphological appearance may be a false positive < 2% of tumors are negative for CD 117 Such tumors are labeled “Stromal cell neoplasm most consistent with GIST” 60-70% of tumors are also positive for CD 34
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Benign Vs Malignant Features favoring benign lesions in general like: Size less than 5 cm Low number of mitosis per HPF No mucosal invasion
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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cagas11 - Gastrointestinal Stromal Tumors Aruna Kommareddy,...

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