GIST, Pathology, CD117, Morphology
BACKGROUND
Gastrointestinal Stromal Tumours (GIST) are a rare mesenchymal malignancy of the Gastrointestinal (GI) tract. GISTs originate from Interstitial Cells of Cajal, the pacemaker cell of the gut. Over the last decade, GISTs have gone from a surgical obscurity to a tumour of extreme interest not only to surgeons but also to oncologists. Surgical management is the mainstay of therapy. They can be benign or malignant in nature. This study aims to analyse the clinical spectrum and various histomorphological features.
Aims-
1. To study the modes of presentation of Gastrointestinal Stromal Tumour, 2. To study the sites of lesion in Gastrointestinal Stromal Tumour, 3. To analyse the stage of presentation of the cases of GIST presenting in Calicut Medical College, 4. To study the pathology (histopathology and immunohistochemistry) to prognosticate the disease. Settings- Department of General Surgery and Gastrosurgery, Medical College Kozhikode, Sample Size- 44 cases over a period of 2 years, Study Period- Jan 2011- December 2012 (2 years), Design of Study- Descriptive Study, Design- Case Control Study.
MATERIALS AND METHODS
Detailed history was taken with regard to the age, sex, mode of presentation, site of lesion, pathology (histopathology and immunohistochemistry). Relevant investigations like CBC, RBS, RFT, LFT, SE, PT-INR, USG abdomen, CECT abdomen, histopathology of specimen including the size and the number of mitosis per high power field and study of immunohistochemistry CD117, performed. The operative findings including tumour size and location and postoperative complications were studied for comparative analysis. Statistical Analysis- SPSS 16.
RESULTS
1. Predominant male affection with a ratio of 1.4:1;
2. Patients presented predominantly with gastrointestinal haemorrhage, i.e. hematemesis and melaena was found in 65% patients;
3. In this study the most common site was found to be stomach 63.6%, followed by small bowel which comprises 25% and colon comprising 4.5%;
4. No specific risk factors with statistical significance could be identified among the cases in the study;
5. In about 25% cases in the study, the average tumour size was more than 10 cms;
6. 63.5% cases of GIST presented with spindle cell morphology and 25% epithelioid morphology;
7. 43 out of 44 cases (97.7%) were positive for CD117.
CONCLUSION
1. GIST can occur anywhere along the GI tract, from oesophagus to the rectum; 2. Of the 44 cases studied during the period 2011 – 2012, there were 26 males and 18 females with a male-to-female ratio of 1.4: 1; 3. The median age group is 60 - 70 years; 4. The predominant site was stomach, 63.6% cases. Gastrointestinal haemorrhage is the most common mode of presentation; 5. Size of tumour and mitotic rate were consistent with malignant behaviour of tumour.
KEYWORDS
GIST, Pathology, CD117, Morphology.
