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  1. Fulltext Successful surgical resection of advanced gastrointestinal stromal tumor post neoadjuvent therapy
    Kamil S, Biswas M, Imran A, Islam R, Mukhtar A, Joshi S
    Libyan J Med, 2009 Jun 01;4(2):83-5.
    PMID: 21483516 DOI: 10.4176/081220
    We report a case of a 48-year-old Indian male who presented with swelling and firmness in his left upper part of the abdomen of one month duration with anorexia and weight loss. Initial examination revealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleural effusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour (GISTs) as supported by immmunohistochemistry results which showed strong positivity for c-kit while stains for smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. The patient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate 400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twenty months and was tolerated well by the patient. It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is currently on Imatinib mesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinib on surgical resection rates and post operative outcomes is limited especially with primary locally advanced GISTs. In our case successful surgical resection was possible for a huge locally advanced GIST with unusually prolonged treatment of twenty months with imatinib preoperatively.
    Matched MeSH terms: Gastrointestinal Stromal Tumors*
  2. Laparoendoscopic Transgastric Enucleation of an awkwardly sited Peri-Cardial Gastrointestinal Stromal Tumour (GIST): A Multi- Modal Approach
    Kosai NR, Rajan R, Roslani EJ, Sutton PA, Mustafa M, Das S
    Clin Ter, 2015 Nov-Dec;166(6):248-52.
    PMID: 26794812 DOI: 10.7417/CT.2015.1896
    In the modern era of surgery, minimally invasive surgery is increasingly applied for excision of gastrointestinal stromal tumors. Site, size and tumor location are important factors that affect the surgical approach and excision. We performed a laparoendoscopic transgastric enucleation of a 4-cm pericardial endophytic gastrointestinal stromal tumor (GIST) using an energy device. The surgery was successful and post-operative recovery uneventful. No tumor recurrence was detected on surveillance gastroscopy. In the safe hands of a well-trained laparoscopic upper gastrointestinal surgeon, pericardial GIST can be enucleated safely by this method. The avoidance of surgical staplers is not only cost-effective, but also reduces the risk of associated complications.
    Matched MeSH terms: Gastrointestinal Stromal Tumors*
  3. Gastric Schwannoma in an elderly man: A case report
    Mohamad MA, Jarmin R, Md Pauzi SH
    Malays J Pathol, 2020 Dec;42(3):455-459.
    PMID: 33361729
    Schwannomas are mesenchymal tumors that are characteristically benign and slow growing, which originate from any nerve with Schwann cell sheath. Gastrointestinal schwannomas are rare with distinct morphologic features as compared to schwannomas of soft tissue or central nervous system. A 77-year-old male patient was diagnosed with gastrointestinal stromal tumor based on radiological findings and clinical impression when he presented with worsening abdominal discomfort and pain. He underwent distal gastrectomy however histopathological examination of the tumour revealed schwannoma. This case report presents a rare case of a symptomatic gastric schwannoma, whose definitive diagnosis was established by histopathological and immunohistochemical findings postoperatively.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/diagnosis; Gastrointestinal Stromal Tumors/pathology
  4. Fulltext Stomach gastrointestinal stromal tumours (GIST) intussuscepted into duodenum : a case report
    Siam FA, Siow SL
    Malays J Med Sci, 2008 Oct;15(4):68-70.
    PMID: 22589640
    Gastrointestinal stromal tumours (GIST) are tumours of gastrointestinal tract and mesentery. The commonest site of its occurrence is the stomach. Patients with GIST are usually asymptomatic but they can present as abdominal pain, bleeding and rarely gastric outlet obstruction. In this particular case, the patient presents with symptoms of anaemia, partial gastric outlet obstruction and intermittent epigastric pain. Laparotomy was performed and a diagnosis of gastroduodenal intussusception secondary to gastrointestinal stromal tumour was made.
    Matched MeSH terms: Gastrointestinal Stromal Tumors*
  5. Fulltext An immunohistochemical and molecular study of gastrointestinal stromal tumours
    Teong YT, Teo ST, Tan LP, Wu BQ, Peh SC
    Med J Malaysia, 2006 Dec;61(5):526-33.
    PMID: 17623951 MyJurnal
    Gastrointestinal stromal tumour (GIST) is a rare but most common mesenchymal tumour in the gastrointestinal tract. Although GIST research has been carried out extensively worldwide, it has yet to be studied in Malaysia. To establish the immunohistochemical expression pattern of CD117 (c-KIT), CD34, S-100 and Desmin, the incidence of c-KIT and PDGFRA genes mutation in GISTs, and correlate it with clinicopathological parameters. Eleven clinically diagnosed GISTs were stained for CD117, CD34, Desmin and S-100 protein by immunohistochemical technique, and c-KITand PDGFRA gene mutations were studied by PCR-CSGE-DNA sequencing method. All GISTs (7 cases) stain positive for CD117, and co-expressed CD34. None of these cases express Desmin, and only one expressed S-100 protein focally. Fifty-seven percent (4/7 cases) of GIST harboured mutations at exon 11 of c-KIT gene, and they were all high risk and malignant cases. No mutation was detected at exons 9, 13 and 17 of KIT gene, and exons 12 and 18 of PDGFRA gene. Immunohistochemistry using a panel of antibodies shows consistent pattern of CD117 and CD34 expression in GIST, and mutational study may be a useful prognostic marker for kinase inhibitor treatment of GIST.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/diagnosis*; Gastrointestinal Stromal Tumors/genetics; Gastrointestinal Stromal Tumors/immunology; Gastrointestinal Stromal Tumors/pathology
  6. Fulltext Bleeding jejunal GIST: An uncommon cause of gastrointestinal bleeding
    Mohanaraj T, Hanif H, Zainal AA
    Med J Malaysia, 2015 Feb;70(1):31-2.
    PMID: 26032526 MyJurnal
    Gastrointestinal stromal tumours (GIST) are rare gastrointestinal tumours and are one of the causes of obscure gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding secondary to bleeding jejunal GIST in a 43 years old gentleman. Endoscopic intervention failed to identify the source of bleeding and CT Angiography (CTA) showed a jejunal mass and patient underwent laparotomy and resection of the bleeding jejunal GIST. This article highlights the rare cause of the massive GI bleeding and also emphasise the role of CTA in obscure GI bleeding.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
  7. Fulltext A case of gastrointestinal stromal tumour mimicking uterine fibroid
    Nurhayati, A., Aida Hani, M.K., Nik Muhd Aslan, A., Reena Rahayu, M.Z., Ani Amelia, Z.
    Journal of Surgical Academia, 2017;7(1):69-71.
    MyJurnal
    Gastrointestinal stromal tumour (GIST) is extremely rare with reported incidence of 20 per million per year. It is the most common mesenchymal tumour of the gastrointestinal tract. When it occurs at the pelvis in a female patient, it can be misleading to a gynaecological diagnosis. Non gynaecological diagnosis such as GIST must be considered in patients with pelvic mass presenting with atypical symptoms.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
  8. Diagnostic conundrum of a perineal tumour: a rectal gastrointestinal stromal tumour mimic
    Shi R, Chew MH, Leow WQ
    Malays J Pathol, 2017 Dec;39(3):293-296.
    PMID: 29279593
    Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/diagnosis*; Gastrointestinal Stromal Tumors/pathology
  9. Fulltext Histomorphology and Immunohistochemistry of Gastrointestinal Stromal Tumors in a Malaysian Population
    Kkrishnappa P, Loh EJ, Mohamad IB, Tata MD, Akhilesh M, Palayan K
    Asian Pac J Cancer Prev, 2016;17(6):2795-9.
    PMID: 27356692
    PURPOSE: To study histomorphological and immunohistochemical patterns of gastro-intestinal stromal tumours (GISTs) in Malaysia.

    MATERIALS AND METHODS: A total of 29 GIST cases from Hospital Tuanku Ja'afar, Seremban ,were studied retrospectively over a period of 10 years from January 2002 to December 2011. Patient demographic data like age, sex and etnicity were collected. Tumour characteristics like site, maximum dimension and specimen type were analysed. Evaluation was according to established criteria into very low, low, intermediate and high-risk categories. Immunohistochemical characteristics were also analysed.

    RESULTS: The mean age of patients was 59.7 years. Males (59%) were found to be more commonly affected than females (41%). The Chinese (45%) were commonly affected than Malays (41%), and Indians (10%). The most common symptom was pain in the abdomen (13.8%). More than half of the cases were seen in stomach (53%). The tumour size ranged from 1.5 cm to 17 cm with a mean of 6.94cm. Microscopic findings revealed that the spindle cell type was the most common (76%). It was observed that the majority of the cases (48%) were categorised in the intermediate risk group. Immunohistochemical staining showed positivity for CD117 (78.6%), CD34 (71.4%), vimentin (86.2%), S-100 (27.6%), SMA (35.7%), PKC THETA (46.4%) and PDGRFA (67.9%).
    Matched MeSH terms: Gastrointestinal Stromal Tumors/metabolism; Gastrointestinal Stromal Tumors/epidemiology*; Gastrointestinal Stromal Tumors/pathology*
  10. Fulltext Gastrointestinal stromal tumors (GIST) in a patient with Neurofibromatosis: A case report
    Zailani, M.H., Naqiyah, I., Rohaizak, M., Siti Aishah, M.A.
    International Medical Journal Malaysia, 2007;6(1):1-5.
    MyJurnal
    Type 1 Neurofibromatosis (von Reckinghausen’s disease) has been associated with several gastrointestinal tumor complications, either benign or malignant. We report a case of a middle age man who had Type 1 Neurofibromatosis and presented with acute intestinal obstruction. Laparotomy revealed multiple nodular lesions along the small intestine with two larger nodules which were resected. Histopathological examination of the nodules confirmed it as gastrointestinal stromal tumors (GIST) with malignant potential. The association between neurofibromatosis and GIST is discussed.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
  11. Upper gastrointestinal tract bleeding caused by a gastrointestinal stromal tumor of the stomach: a case report
    Al-Hendal A, Al-Sabbagh AJ, Al-Mishaan M, Abo Dief W
    Gulf J Oncolog, 2010 Jul.
    PMID: 20601339
    We report a case of upper gastrointestinal bleeding caused by a gastrointestinal stromal tumor in a 50-year old man. The patient was having melena for two months, and on admission he was hemodynamically stable. Upper G.I endoscopy showed diffuse gastritis and an extrinsic compressing mass in the upper part of the stomach. CT scan of the abdomen showed exophytic mass in the fundus of the stomach, with central necrosis. The patient was submitted to operative management. There were no features of dissemination but there was invasion of the hilum of the spleen. Wide local resection and splenectomy performed. Post operative course was complicated by a bleeding from the anastomotic site that required re-exploration and suturing of the bleeding vessel. Histologic examination revealed that it was composed of spindle-shaped cells with elongated nuclei. Post operatively the patient received adjuvant treatment with Imatinib [Gleevec]. The patient has an uneventful follow-up period so far.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/complications*
  12. Fulltext Laparoscopic transgastric resection for intraluminal gastric gastrointestinal stromal tumors located at the posterior wall and near the gastroesophageal junction
    Siow SL, Mahendran HA, Wong CM
    Asian J Surg, 2017 Sep;40(5):407-414.
    PMID: 26922628 DOI: 10.1016/j.asjsur.2015.12.001
    OBJECTIVE: Intraluminal gastric gastrointestinal stromal tumors (GISTs) located at the posterior wall and near the gastroesophageal junction represent a surgical challenge. We present our experience of laparoscopic transgastric resection for gastric GISTs of such location.

    METHODS: Data of seven patients undergoing laparoscopic transgastric resection were identified and retrospectively reviewed with regard to procedural steps and patient outcomes.

    RESULTS: Seven patients (4 men; mean age 64.1 ± 14.6 years) with gastric GISTs underwent laparoscopic transgastric resection from January 2010 to May 2015. Three of the seven GISTs were located near the gastroesophageal junction and the rest were found in the posterior wall of the stomach. All seven patients underwent successful laparoscopic resection without any conversions. There were no mortalities and no significant postoperative complications. Intraoperative endoscopy was performed for all patients. The mean operative time was 164.0 ± 59.1 minutes. Regular diet was resumed within 3 days on average and mean postoperative stay was 3.6 ± 1.3 days. All patients achieved complete R0 resection with a mean tumor size of 5.5 ± 1.1 cm. At a mean follow-up of 48.0 ± 13.4 months, all patients were recurrence free.

    CONCLUSIONS: GISTs of the posterior wall and in close proximity to the gastroesophageal junction can be safely resected laparoscopically using such an approach. Standard technique is required to achieve good oncological outcomes.

    Matched MeSH terms: Gastrointestinal Stromal Tumors/surgery*
  13. Fulltext Gastric duplication cyst with a red flag presentation: a case report
    Alagoo D, Sellappan H, Jayasilan J, Azizan N, Hayati F
    Pan Afr Med J, 2021;39:141.
    PMID: 34527157 DOI: 10.11604/pamj.2021.39.141.29895
    Gastric duplication cyst (GDC) is a rare congenital malformation of the gastrointestinal (GI) tract. Despite being benign in the entity, its complications vary from an asymptomatic abdominal mass to fulminant or massive GI bleeding. A 28-year-old lady presented with unexplained GI haemorrhage, in which the upper endoscopy showed a classic feature of GI stromal tumour. The preoperative diagnosis was also confirmed by the computed tomography. She subsequently underwent surgical resection and the final histopathology was consistent with a benign entity of GDC.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/diagnosis
  14. Fulltext A clinical and immunohistochemical study of gastrointestinal stromal tumours
    Khoo JJ, Gunn A
    Malays J Pathol, 2005 Jun;27(1):9-16.
    PMID: 16676687
    AIM: To study the clinical features, histology and immunohistochemical properties of gastrointestinal stromal tumours (GISTs); and establish any parameters that can help prognosticate the malignant potential.
    METHODS: Twenty-six patients with GISTs who were seen in Sultanah Aminah Hospital Johor, Malaysia from 1999 to 2003 were selected for study. Patient, clinical characteristics and outcome based on surgical records were analysed. Tumour variables (tumour size, cellularity, mitotic count, necrosis and haemorrhage) were compared between very low to low risk groups and intermediate to high risk groups. The immunohistochemical properties of GISTs were also studied.
    RESULTS: Patients with GISTs presented mainly with pain, palpable mass or gastrointestinal tract bleeding. The tumours were seen in stomach (50%) followed by small intestine (38.5%) and rectum (11.5%). In the period of study, six patients had metastasis, mainly in the liver or peritoneum. Immunoreactivity for CD117, CD34, vimentin, S100, neuron specific enolase, alpha-smooth-muscle-actin and desmin were observed in 100%, 76.9%, 61.5%, 46.1%, 80.8%, 11.5% and 0% of tumours respectively. The behaviour of GISTs was largely dependent on tumour size and number of mitosis. Necrosis and haemorrhage were seen in tumours with high risk potential.
    Matched MeSH terms: Gastrointestinal Stromal Tumors/metabolism*; Gastrointestinal Stromal Tumors/pathology
  15. An oncological curiosity of a male patient with a huge leiomyoma of the terminal ileum
    Zainudin S, Rajanthran SK, Azizan N, Hayati F, Ginawoi J, Suhaimi KA, et al.
    Oxf Med Case Reports, 2020 Oct;2020(10):omaa086.
    PMID: 33133619 DOI: 10.1093/omcr/omaa086
    Leiomyoma is a smooth muscle tumour that can arise in any part of the body especially the uterus. Even though it is traditionally linked with hormonal influence, it can also develop in extrauterine organs with a slight female predominance. It is indistinguishable with gastrointestinal stromal tumour (GIST) histologically. We report a case of a 30-year-old gentleman who presented with a huge painful mass in the right iliac fossa. Computed tomography revealed a 10 × 10 cm homogeneous mass arising from the terminal ileum; he subsequently underwent an open right hemicolectomy. Histology showed a well-circumscribed lesion composed of interlacing bundles of smooth muscle fibres of the submucosa with positive smooth muscle actin and H-Caldesmon stains but negative for DOG-1 and CD117 (c-kit) stains which were consistent with leiomyoma. Despite its rarity, this hormone-related tumour needs to be considered regardless of gender. Immunohistochemistry is paramount as it is histologically identical to GIST.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
  16. Fulltext A review of gastrointestinal stromal tumours- a single centre experience
    Muhammad, Z.R., Norra, H., Suhaila, A., Norlelawati, A.T., Naznin, M.C.
    International Medical Journal Malaysia, 2016;15(2):63-68.
    MyJurnal
    Introduction: Gastrointestinal stromal tumour (GIST) is relatively rare. The clinical behaviour of GIST ranges
    from benign to frank sarcoma. The diagnosis is established through histopathological examination and
    immunohistochemistry profile. In Malaysia, the number of publications related to GIST is relatively rare. This
    study was therefore conducted to examine the demographic, histopathological and immunohistochemical
    features of GIST cases diagnosed in the Department of Pathology, Hospital Tengku Ampuan Afzan, Kuantan,
    Pahang from 2009 until 2014. Methods: Past histopathological records were reviewed. Demographic and
    histopathological and immunohistochemical data of patients diagnosed were collected. Results: There were
    28 cases (14 males and 14 females) diagnosed as GIST. Mean age was 56.4 years, and the majority were
    above 40 years of age (85.7%). Stomach was the most common location (42.9%), followed by small intestine
    (28.6%). In 23 cases (82%), the tumours exhibited spindle cell morphology, while epithelioid cell and mixed
    cell types were seen in 3 cases (11%) and 2 cases (7%), respectively. Five cases were categorised as very low
    risk to low risk behaviour, while 18 cases were intermediate to high. None of the histological parameters
    analysed which include tumour morphology, necrosis, haemorrhage, nuclear atypia and mean number of
    mitoses showed significance difference between the different risk behaviour groups. Positivity with KIT
    (CD117), considered to be the defining immunohistochemistry feature, was negative in 2 cases. Conclusion:
    Although this study is a retrospective study, the findings contribute to the knowledge on GISTS in Malaysia.
    Future research related to GISTs in Malaysia should focus on molecular analyses for KIT and PDGFRA
    mutations for diagnostic confirmation especially in KIT-negative cases and also for the purpose of
    therapeutic response correlations.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
  17. Fulltext Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy. A case report
    Dualim DM, Loo GH, Rajan R, Nik Mahmood NRK
    Int J Surg Case Rep, 2019;60:303-306.
    PMID: 31277041 DOI: 10.1016/j.ijscr.2019.06.053
    INTRODUCTION: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the alimentary tract but accounts for only 0.1-3% of all gastrointestinal neoplasms. The most common presentation of GISTs is acute or chronic gastrointestinal bleeding, in which the patient presents with symptomatic anaemia.

    PRESENTATION OF CASE: With that in mind, we describe a 66-year-old man who presented with recurrent episodes of obscure gastrointestinal bleeding for two years. Video capsule endoscopy (VCE) showed several small telangiectasias in the proximal small bowel. Oral route double-balloon enteroscopy (DBE) revealed abnormal mucosa 165 cm from incisor with central ulceration and vascular component. He subsequently underwent surgical excision. The histopathological report confirmed the diagnosis of GIST arising from the jejunum. During his clinic follow up, he remains symptom-free with no evidence of recurrence.

    DISCUSSION: The diagnosis of bleeding small intestine GISTs can be challenging as these are inaccessible by conventional endoscopy. Imaging modalities such as double-balloon enteroscopy, capsule endoscopy, CT angiography, intravenous contrast-enhanced multidetector row CT (MDCT) and magnetic resonance enterography (MRE) have been used to assist in the diagnosis of bleeding small intestine GISTs. The mainstay of management for small intestine GIST is complete surgical excision.

    CONCLUSION: Bleeding jejunal GIST is very rare and only a handful of case reports have been published. The mainstay of management for small intestine GIST is complete surgical excision. It is essential to obtain a complete excision of localised disease and avoiding tumour spillage in order to reduce the risk of local recurrence and metastatic spread of GISTs.

    Matched MeSH terms: Gastrointestinal Stromal Tumors
  18. Fulltext C-kit proto-oncogene expression in uterine leiomyosarcomas: case series
    Naik, V.R., Hasnan, J.
    International Medical Journal Malaysia, 2008;7(2):51-54.
    MyJurnal
    Introduction: The proto-oncogene c-kit is the cellular homologue of the oncogene v-kit of HZ4 feline sarcoma virus. It is located on chromosome 4 (4q11-12) in the human genome. Interaction between the c-kit receptor and its ligand, stem cell factor, is essential in the development of tissues. C-kit expression has been identified in a number of different neoplasms like seminoma/dysgerminoma, and gastrointestinal stromal tumors (GIST). Recently it has been reported that c-kit is also present in leiomyosarcomas. Tyrosine kinase inhibitors (TKIs) are a promising new therapy in the treatment of cancer. These agents target cellular proteins like kit and its related homologues decreasing cellular proliferation and survival. TKIs may be helpful in treating leiomyosarcomas expressing c-kit. Materials and Methods: In this study a total of 6 cases diagnosed as leiomyosarcomas at Department of Pathology, Universiti Sains Malaysia, Kubang Kerian, Malaysia, were investigated for reactivity for c-kit using immunohistochemical stain. Stain was considered positive if more than 10 percent of the cells showed membrane or cytoplasmic positivity. Results: Two leiomyosarcomas stained faintly with c-kit and in less than 10 percent of the cells. The other 4 cases showed no staining. The control showed good membrane and cytoplasmic positivity. Conclusion: Uterine leiomyosarcomas did not express c-kit. The reason for this could be that the tumors are inherently c-kit negative. More study using larger number of cases is required to validate these findings and further molecular characterization of these mesenchymal tumors is needed to identify the true nature of these sarcomas.
    Matched MeSH terms: Gastrointestinal Stromal Tumors
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