| Abstract [eng] |
Background / objective A scientific and clinical interest in GISTs which have earlier been named leiomyoma, leiomyosarcoma as well as schwannoma is increasing due to new fundamental knowledge. This article was written to review the definitions, clinical presentation, surgical management, prognostic factors, and micromorphology for gastrointestinal stromal tumors of the upper digestive tract. Methods The current selective literature on gastrointestinal stromal tumors has been reviewed. Results Gastrointestinal stromal tumors (GIST) are most frequent neoplasms of mesenchymal origin, which may (10–30%) or may not (70–90%) be malignant. Malignant GIST rarely metastasize to distal organs. Clinical findings include acute gastrointestinal bleeding, obstruction, abdominal pain. All symptomatic GIST of the upper digestive tract as well as middle-size asymptomatic tumors (gastric tumors >2 cm in diamether ) should be removed. In events of bleeding gastrointestinal stromal tumors the endoscopic methods of treatment are not effective. An operation, either laparoscopic (when it is possible in some cases of small and middle-size tumors) or laparotomic, is the most suitable method of treatment. Laparoscopic wedge gastric resection seems to be a promising operation. Lymph node dissection is not necessary since lymph node involvement is rare and does not seem to influence the prognosis. Unfavourable prognostic factors are tumor size 5 cm or more, invasion to adjacent structures, and high-grade mitotic activity. Immunohistochemical detection of CD117, vimentin, CD34, smooth muscle actin, desmin, S-100 protein and other markers is essential for the diagnostics of GIST as well as other gastrointestinal tract mesenchymal tumors. Conclusions Gastrointestinal mesenchymal tumors earlier classified as leiomyoma (benign), leiomyosarcoma (malignant), schwannoma should be termed gastrointestinal stromal or mesenchymal tumors. Immunohistochemistry should become an essential method of postoperative diagnosis. . |
