GI Stromal Tumors: Surgery or Tyrosine Kinase Inhibitors?

An 85-year-old man was hospitalized because of lower GI bleeding. He was hemodynamically stable. Because gastroscopy and colonoscopy failed to reveal the source of the bleeding, push enteroscopy was performed. This study showed an ulcerated tumor in the proximal jejunum.

The patient underwent a laparotomy and partial small-bowel resection with anastomosis of the portion of jejunum; his recovery was uneventful. The resected tumorous mass (A) and a well-defined segment of its submucosa (B) are shown. Histologic examination of the mass revealed findings characteristic of a GI stromal tumor.

Virendra Parikh, MD, of Fort Wayne, Ind, writes that the term "GI stromal tumor" is used preferentially to describe mesenchymal tumors specific to the GI tract; it encompasses most GI tumors previously designated as leiomyomas, leiomyoblastomas, and leiomyosarcomas. GI stromal tumors can develop anywhere along the GI tract, but are most commonly found in the stomach (60%), followed by the small intestine (30%) and other sites (10%).¹

The mainstay of treatment is complete removal of the tumor. When surgery is not an option, conventional chemotherapy and radiation therapy may be used; however, GI stromal tumors respond poorly to these therapies. Tyrosine kinase inhibitors, such as imatinib mesylate, may play a role in the treatment of advanced and unresectable tumors.²

References:

REFERENCEs:

1.

Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology.

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1999;30: 1213-1220.

2.

Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors.

N Engl J Med.

2002; 347:472-480.