An entity that should be kept in mind: Synchronous gastrointestinal stromal tumor encountered in resection materials obtained for the detection of intra-abdominal malignancies

Our plain-English summary of An entity that should be kept in mind: Synchronous gastrointestinal stromal tumor encountered in resection materials obtained for the detection of intra-abdominal malignancies, by S.S. Erhan, G. Kulduk, A. Dobral, et al (Northern Clinics of Istanbul, 2023).

The study

• Authors: S.S. Erhan, G. Kulduk, A. Dobral, A. Bugra
• Journal: Northern Clinics of Istanbul
• Published: 2023;10(6):797-802
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Gastrointestinal stromal tumors (GISTs), often sporadic, arise from interstitial Cajal cells of the gastrointestinal tract or their stem cell-like precursors. Apart from tumor-associated syndromes, it has been reported that GISTs are also associated with other tumors. There is no clear information about the etiology of these synchronous tumors. In this study, we wanted to present the clinicopathological features of 13 cases diagnosed as synchronous GIST with other tumors.

Methods: Demographic characteristics of the cases, risk of progressive disease score, tumor localization, size, and the mitotic activity of tumors along with survival status were evaluated.

Results: Thirteen of 101 cases diagnosed with GIST had a primary tumor synchronous with GIST. Synchronous GISTs were located in the stomach and small intestine. Most of the cases were detected incidentally in the intraoperative and post-operative periods. Risk scores for progressive disease were categorized as low (n=1), very low (n=1), and no risk (n=11). Non-GIST tumors were located in the stomach, transverse colon, left colon, rectum, gallbladder, kidney, and retroperitoneal space. Histological tumor types were adenocarcinoma, diffuse large B-cell lymphoma, mesothelioma, and neuroendocrine tumor. Life expectancy was found to be significantly lower in synchronous GISTs.

Conclusion: In cases operated for non-GIST tumors, the possibility of incidental detection of GIST should always be kept in mind.

© Copyright 2023 by Istanbul Provincial Directorate of Health.

In plain English

This was a case series from a pathology department in Istanbul, Turkiye. The authors reviewed 101 cases of gastrointestinal stromal tumor (GIST) diagnosed between 2007 and 2020. In 13 of the 101 cases (12.9%), the patient also had a second, separate primary tumor at the same time. In these 13 cases the GISTs were in the stomach (7) or small intestine (6) and measured 0.4 to 3.5 cm. Only one was found before surgery. Six were found by the surgeon during the operation and six by the pathologist examining the removed tissue. Eleven of the 13 GISTs were scored as no risk of progressive disease. The most common second tumor was adenocarcinoma (9 cases). One second tumor was a mesothelioma, listed in the gallbladder. Seven of the 13 patients died during follow-up. Average life expectancy was significantly lower in patients with synchronous GISTs (p=0.007). The authors suggested this may reflect the aggressive course of the other cancers. The authors concluded that GIST may be found incidentally during surgery for other tumors. The article does not discuss asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-institution case series of GISTs coexisting with other primary tumors
• Who was studied: 101 patients diagnosed with GIST between 2007 and 2020 at Prof. Dr. Cemil Tascioglu City Hospital, Istanbul; 13 of them had a synchronous second primary tumor
• Exposure: No asbestos or other exposure was studied. The article examined GISTs occurring at the same time as other primary tumors.
• Main results:
  • 13 of 101 GIST cases (12.9%) had a second primary tumor other than GIST
  • Among the 13 synchronous cases, the GIST was in the stomach in 53.8% (n=7) and in the small intestine in 46.2% (n=6)
  • In the 13 synchronous cases, GIST diameters ranged from 0.4 to 3.5 cm, and 7 were 1 cm or less
  • Among the 13 synchronous cases, 1 GIST was detected before surgery, 6 by the surgeon during the operation, and 6 by the pathologist during examination of the resected material
  • Among the 13 synchronous GISTs, 11 were in the no-risk category, 1 very low risk and 1 low risk for progressive disease
  • Among the 13 second tumors, adenocarcinoma was the most common type (n=9). The others were renal cell carcinoma, diffuse large B-cell lymphoma, mesothelioma and neuroendocrine tumor.
  • One second tumor was a mesothelioma. Table 2 lists it in the gallbladder of an 80-year-old woman with a 1.5 cm small intestine GIST. The mesothelioma and lymphoma cases had a higher pathological grade.
  • During follow-up, 7 of the 13 patients with synchronous GIST died
  • Average life expectancy was significantly lower in patients with synchronous GISTs than in GIST patients without another tumor (p=0.007)
• The authors' conclusion: The authors concluded that the possibility of incidentally finding GIST in patients operated on for other tumors should always be kept in mind, and that such tumors may be more common than thought. They suggested the shorter survival may be related to the aggressive course of the other cancers.
• Limitations the authors state:
  • No molecular testing for c-kit mutation was done on the cases

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, STEM, Etiology, Adenocarcinoma, Mesothelioma, Life Expectancy.

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