Amr H. Sleema MD; Ihab S. Fayeka MD; Hany F. Habashyb MD;Amany Saberc MD;Alfred E. Namourd MD;Nevine F. Habashye MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University – Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University – Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University – Egypt.
Kasr el-aini journal of surgery Volume 15, No.2, May 2014
Abstract
Metastatic gastric tumors (MGTs) mean the tumor cells that attack the stomach and grow there through blood vessel, lymph vessel, and other pathway, consistent with the primary tumor in phenotype, which are clinically uncommon, and information on MGTs is generally limited to single case reports. Here we present a clinical series of 8 cases with MGTs, in attention to discuss the clinical characteristics, diagnosis and treatment, and prognosis of MGTs. Our data showed that MGTs are rare, with a male predominance, and the cause of death was multiple organ metastases in most cases. Heterochromous MGTs showed a significantly better prognosis than simultaneous MGTs, and a long interval between initial radical excision of the primary tumor and appearance of gastric metastasis was found to be associated with good prognosis.
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
Abstract
Metastatic gastric tumors (MGTs) mean the tumor cells that attack the stomach and grow there through blood vessel, lymph vessel, and other pathway, consistent with the primary tumor in phenotype, which are clinically uncommon, and information on MGTs is generally limited to single case reports. Here we present a clinical series of 8 cases with MGTs, in attention to discuss the clinical characteristics, diagnosis and treatment, and prognosis of MGTs. Our data showed that MGTs are rare, with a male predominance, and the cause of death was multiple organ metastases in most cases. Heterochromous MGTs showed a significantly better prognosis than simultaneous MGTs, and a long interval between initial radical excision of the primary tumor and appearance of gastric metastasis was found to be associated with good prognosis.
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
Pr Olivier Glehen (Lyon - France) presents HIPEC in treatment for colorectal and gastric carcinomatosis. La CHIP dans le traitement des carcinoses péritonéales d'origine colorectale et gastrique.
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Post radical nephroureterectomy cystoscopic surveillance and usage of a nomog...NAAR Journal
Aim:Intravesical recurrence post radical nephroureterectomy (RNU) is a frequent event requiring intense cystoscopic surveillance. This study includes cystoscopic surveillance and usage of variable predictors for intravesical recurrence after radical nephroureterectomy. The current investigation objective was to recognize intravesical recurrence indicators and build up a tool to allow risk delineated methodology supporting patient advising for cystoscopic surveillance and post-operative intravesical MMC administration. Methods: We did a retrospective analysis of 324 patients with UTUC (Upper Tract Urothelial Carcinoma). Patients' demographic data, including age, gender, etiology, tumor size, previous bladder cancer, tumor location (renal pelvic or ureter), were reported. All the patients reported above were followed up for a mean period of 36 months. Computed tomography (CT), ultrasound imaging, cystoscopy, urine cytology, ureteroscopy tests were performed for each patient included in the study. The data set was divided into a development cohort of recurrent and non-recurrent patients). Multivariable and Univariable were addressed to intravesical recurrence after RNU. Predictive accuracy was quantified. Result:With a median follow-up of 36 months, intravesical recurrence occurred in 59 patients. IVR after RNU was noted in 59 patients after a median follow-up of 36 months. The probability of intravesical recurrence is 28.6%.The recurrent bladder tumors were managed with endoscopic resection and intravesical chemoimmunotherapy following the standard protocol. The recurrent bladder tumors showed the following characteristics: 3.4%, 3.4%, 8.5%, 37.3%, and 47.5% of tumors were in Ta, T1, T2, T3, and T4stages, respectively. One patient underwent radical cystectomy after a refractory muscle-invasive bladder tumor, and contralateral UTUC developed. Two patients had partial cystectomy after multiple endoscopic resections of T1 tumor, and intravesical chemotherapy failed. For 59 patients who developed bladder recurrence, the optimal cut-off point of early recurrence was determined to be six months after surgery (p=0.042). End-stage renal disease history and surgical margin positive patient has later bladder recurrence.
A Coliseum with frail foundations: a critical analysis of the state-of-the-ar...Marco Lotti
Some considerations that made me convinced that the Coliseum HIPEC technique cannot be considered an adequate technique for the delivery of Hyperthermia.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
Peritoneal Surgery and
Intraperitoneal Chemotherapy, presented by Garrett Nash, MD of Memorial Sloan-Kettering at the Mesothelioma Applied Research Foundation's conference in New York, NY on September 28, 2012. www.curemeso.org
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Post radical nephroureterectomy cystoscopic surveillance and usage of a nomog...NAAR Journal
Aim:Intravesical recurrence post radical nephroureterectomy (RNU) is a frequent event requiring intense cystoscopic surveillance. This study includes cystoscopic surveillance and usage of variable predictors for intravesical recurrence after radical nephroureterectomy. The current investigation objective was to recognize intravesical recurrence indicators and build up a tool to allow risk delineated methodology supporting patient advising for cystoscopic surveillance and post-operative intravesical MMC administration. Methods: We did a retrospective analysis of 324 patients with UTUC (Upper Tract Urothelial Carcinoma). Patients' demographic data, including age, gender, etiology, tumor size, previous bladder cancer, tumor location (renal pelvic or ureter), were reported. All the patients reported above were followed up for a mean period of 36 months. Computed tomography (CT), ultrasound imaging, cystoscopy, urine cytology, ureteroscopy tests were performed for each patient included in the study. The data set was divided into a development cohort of recurrent and non-recurrent patients). Multivariable and Univariable were addressed to intravesical recurrence after RNU. Predictive accuracy was quantified. Result:With a median follow-up of 36 months, intravesical recurrence occurred in 59 patients. IVR after RNU was noted in 59 patients after a median follow-up of 36 months. The probability of intravesical recurrence is 28.6%.The recurrent bladder tumors were managed with endoscopic resection and intravesical chemoimmunotherapy following the standard protocol. The recurrent bladder tumors showed the following characteristics: 3.4%, 3.4%, 8.5%, 37.3%, and 47.5% of tumors were in Ta, T1, T2, T3, and T4stages, respectively. One patient underwent radical cystectomy after a refractory muscle-invasive bladder tumor, and contralateral UTUC developed. Two patients had partial cystectomy after multiple endoscopic resections of T1 tumor, and intravesical chemotherapy failed. For 59 patients who developed bladder recurrence, the optimal cut-off point of early recurrence was determined to be six months after surgery (p=0.042). End-stage renal disease history and surgical margin positive patient has later bladder recurrence.
A Coliseum with frail foundations: a critical analysis of the state-of-the-ar...Marco Lotti
Some considerations that made me convinced that the Coliseum HIPEC technique cannot be considered an adequate technique for the delivery of Hyperthermia.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
Peritoneal Surgery and
Intraperitoneal Chemotherapy, presented by Garrett Nash, MD of Memorial Sloan-Kettering at the Mesothelioma Applied Research Foundation's conference in New York, NY on September 28, 2012. www.curemeso.org
How to give Examples for the IELTS Writing Task 2.
For an introduction on how to start IELTS Writing Task 2 click here:
www.ieltspodcast.com/ielts-writing-task/ielts-writing-start-ielts-writing-task-2/
How to Start IELTS Writing Task 2. 5 minute tutorial.Ben Worthington
To watch the video with have a look here: http://www.ieltspodcast.com/uncategorized/guide-to-ielts-writing-task-2/
For an introduction on how to start IELTS Writing Task 2 click here:
www.ieltspodcast.com/ielts-writing-task/ielts-writing-start-ielts-writing-task-2/
www.ielts-expert.pk IELTS in Karachi,IELTS preparation in Karachi, Best IELTS Preparation in Karachi, IELTS classes in Karachi, Best IELTS Institute in Karachi, IELTS Tutor in Karachi, IELTS Institute in Karachi, Ielts in Karachi, ielts preparation in Karachi, ielts classes in Karachi, ielts course in Karachi, ielts institute in Karachi, ielts centre in Karachi, ielts test in Karachi, ielts exam in Karachi, ielts teacher in Karachi, ielts tuition in Karachi, ielts expert in Karachi, ielts online training in Karachi, best ielts institute in Karachi, best ielts classes in Karachi, best ielts tuition in Karachi, best ielts preparation in Karachi, best ielts training in Karachi, best ielts teacher in Karachi, ielts british council in Karachi, aeo in Karachi, ielts result in Karachi, ielts Karachi, ielts preparation Karachi, ielts institute Karachi, ielts course Karachi, ielts test Karachi, ielts coaching Karachi, ielts exam Karachi, ielts online form in Karachi, toefl in Karachi, toefl preparation in Karachi, toefl classes in Karachi, toefl course in Karachi, toefl institute in Karachi, toefl centre in Karachi, toefl test in Karachi, toefl exam in Karachi, toefl teacher in Karachi, toefl tuition in Karachi, toefl expert in Karachi, toefl online training in Karachi, best toefl institute in Karachi, best toefl classes in Karachi, best toefl tuition in Karachi, best toefl preparation in Karachi, best toefl training in Karachi, best toefl teacher in Karachi, aeo in Karachi, toefl ibt Karachi, toefl ibt preparation Karachi, toefl ibt institute Karachi, toefl ibt course Karachi, toefl ibt test Karachi, toefl ibt coaching Karachi, toefl ibt exam Karachi, level A1 english test in karachi pakistan , uk A1 spouse test in karachi pakistan sir Alam, uk spouse visa english language test in karachi by sir Alam, ielts preparation center in karachi, karachi for ielts preparation, best institute for ielts in karachi, ielts karachi institute, best ielts preparation karachi, ielts preparation center in karachi, ielts test dates in karachi, toefl test dates in karachi, aeo test dates in karachi, british council test dates in karachi, australian education office in karachi, IELTS preparation center in karachi, ielts preparation in clifton, ielts teacher in clifton, ielts classes in clifton, ielts tuition in clifton, ielts center in clifton, ielts best teacher in clifton, ielts teacher in dha, ielts teacher in Defence, ielts center in dha, ielts center in Defence, ielts preparation in dha, ielts preparation in Defence, ielts classes in dha, ielts classes in Defence, ielts in DHa, ielts classes in DhA phase v, ielts institute in dha, ielts institue in Defence, IELTS in Pakistan, british council ielts preparation, british council ielts preparation, online ielts preparation test, ielts preparation speaking, ielts preparation pakistan, ielts british council preparation, ielts examination preparation, ielts preparation practice test, ielts preparation online, british counc
IELTS Essay Topics with Answers (writing task 2)Ben Worthington
I look at 5 IELTS Task 2 questions from the topics education, globalisation and gender equality. Audio: http://bit.ly/1kq7NRl
In the audio I explain the process more, but it's an exercise in brain storming for ideas.
For an introduction on how to start IELTS Writing Task 2 click here:
www.ieltspodcast.com/ielts-writing-task/ielts-writing-start-ielts-writing-task-2/
A retrospective study on ovarian cancer with a median follow-up of 36 months ...AI Publications
Ovarian cancer is relatively common but serious and has a poor prognosis. The aim of this study is to highlight the epidemiological, diagnostic, therapeutic and evolutionary aspects of this malignant pathology managed at the Bejaia university hospital center. This is a retrospective and descriptive study over a period of 3 years (2019 - 2022) carried out on 20 patients who developed ovarian cancer. The average age of the patients was 50 years old, 53.23% of whom were over 45 years old. The CA-125 blood test was positive in 18 out of 20 patients. The tumors were discovered on ultrasound in 87.10% of cases and at laparotomy in 12.90%. Total hysterectomy with bilateral adnexectomy was the most performed procedure (64.52%). The early postoperative course was simple. 15 patients underwent second look surgery (16.13%) for locoregional recurrences. Epithelial tumors were the most frequent histological type (93.55%), including 79% in the advanced stage ( IIIc -IV) and 21% in the early stage (Ia- Ib ). Adjuvant chemotherapy was administered in 80% of patients. With a median follow-up of 36 months, 2 patients were lost to follow-up. The evolution was favorable in 27.42% and in 25.81% deaths occurred late postoperatively. Ovarian cancer is not common but serious given the advanced stages and the high rate of late postoperative deaths which were largely observed in patients deprived of adequate neoadjuvant or adjuvant chemotherapy.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Similar to Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases. (16)
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013
Suboccipital lymphadenectomy for patients with occipital squamous cell carcin...Dr./ Ihab Samy
F. Fouad Saleep(1), I. Fayek(1), I. Farahat(2)
(1)National Cancer Institute - Cairo University, Surgical Oncology Department, Cairo, Egypt.
(2)National Cancer Institute - Cairo University, Pathology Department, Cairo, Egypt.
Poster presentation No.3224 at the 17th European Cancer Organization conference ECCO 17, Amsterdam-Netherlands, September 2013.
Impact of dead space closure and lymph vessel ligation during MRM on Post-ope...Dr./ Ihab Samy
Hany F. Habashy MD.a , Ihab S. Fayek MD b , Mohamed I.Abd el aziz MD a
a:Department of Surgery-Fayoum University Hospital-El Fayoum , Egypt.
b:Department of Surgical Oncology –National Cancer Institute – Cairo University ,Egypt.
Kasr el-aini journal of surgery Volume 14, No.2, May 2013
Poster Presentation at the 6th Breast-Gynecological international cancer conference (BGICC) at Fairmont Towers Hotel, Cairo-Egypt on the 9th-10th of January 2014
Sentinel lymph node biopsy before neoadjuvant chemotherapy for clinical axill...Dr./ Ihab Samy
Ihab S. Fayeka MD; Fouad A. Saleepa MD; Hany F. Habashyb MD; Alfred E. Namourc MD ; Iman G. Farahatd MD ;Magdy Kotbe MD
a: department of surgical oncology - national cancer institute - Cairo university - Egypt.
b: department of surgery - Fayoum university hospital - El Fayoum - Egypt.
c: department of medical oncology - national cancer institute - Cairo university - Egypt.
d: department of surgical pathology - national cancer institute - Cairo university - Egypt.
e: department of nuclear medicine - national cancer institute - Cairo university - Egypt.
For correspondance contact: drihab74@hotmail.com
Kasr el-aini journal of surgery Volume 14, No.1, January 2013
Cancer of Oral Cavity Abutting the Mandible; Predictors of Loco-regional Fail...Dr./ Ihab Samy
TAREK K. SABER, M.D.; HESHAM A. HUSSEIN, M.D.; ALI H. MEBEED, M.D.;
HESHAM I. EL SEBAI, M.D.; IHAB SAMI, M.D. and IMAN G. FARAHAT, M.D.*
The Departments of Surgical Oncology and Pathology*, National Cancer Institute, Cairo University.
Journal of the Egyptian Nat. Cancer Inst., Vol. 21, No. 3, September: 219-227, 2009
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Gastrointestinal Stromal Tumors: A clinicopathologic study of 67 cases.
1. 1
Gastrointestinal Stromal Tumors: A
clinicopathologic study of 67 cases.
Amr H. Sleema
MD; Ihab S. Fayeka
MD; Hany F. Habashyb
MD;Amany Saberc
MD;Alfred E. Namourd
MD;Nevine F. Habashye
MD
a: Surgical Oncology Department – National Cancer Institute – Cairo University –
Egypt.
b: Surgery Department – Fayoum teaching hospital – Fayoum University – Egypt.
c: Medical Oncology Department – Minia Cancer Center – Egypt.
d: Medical Oncology Department – National Cancer Institute – Cairo University –
Egypt.
e: Surgical Pathology Department - National Cancer Institute – Cairo University –
Egypt.
Abstract
Aim: Is to study the clinicopathologic aspects of Gastrointestinal Stromal
Tumors (GISTs) with correlation between surgical resection, pathological
characterestics; disease free survival (DFS) and overall survival (OS) for
all cases in a combined retrospective and prospective study.
Patient and methods: A retrospective study for 33 patients with GISTs
at the National Cancer Institute , Minia Oncology Center and Fayoum
Teaching hospital between January 2001- December 2006 and a
prospective study for 34 patients at the National Cancer Institute , Minia
oncology center and Fayoum Teaching hospital between January 2007 -
January 2011. All patients were evaluated pre-operatively and underwent
exploratory laparotomy with surgical resection for curative intent; they
were followed up for a period ranging from 24 to 60 Months.
Results: Among the 67 patients, there were 25 males and 42 females;
77.61% of patients were above 40 years. Abdominal pain (40.3%),
abdominal mass (38.8%) and GIT bleeding (34.8 %) were the main
presentations. The stomach was the most common site of origin of the
disease (49.3%) followed by small intestine (28.4%). Tumors were high
2. 2
grade in (70.1%) and low grade in (29.9%). Complete resection of all
gross disease was accomplished in 53 patients (79.1%) and residual
disease in 14 patients (20.9%).Overall survival and disease free survival
were statistically significant in relation to the size of the tumor, the grade
of the tumor, and the resection status.
Conclusion:Complete surgical resection, including en block resection
of locally advanced tumors, remains the only curative treatment for
GISTs. The overall survival and disease free survival were significantly
affected by size of the tumor, grade of the tumor and the resection status.
Keywords
Gastrointestinal stromal tumor – Sarcoma - CD117 - CD34 – Imatinib -
surgical resection.
Introduction
Gastrointestinal stromal tumors (GISTs) are the most common
mesenchymal tumors of the gastrointestinal tract (1). They account for
1% of all GI tumors. Their origin was at first attributed to interstitial cells
of Cajal, in mesodermal tissue but it has nowadays been recognized that
GISTs arise from multipotential mesenchymal stem cells (2). GISTs are
defined as pleomorphic mesenchymal tumors of the GI tract that express
the KIT protein (CD117-Protooncogene that encodes the transmembrane
tyrosine kinase receptor CD117 and in some gastrointestinal stromal
tumors often also CD34 on immunohistochemistry (3). GISTs
demonstrate a fairly equal distribution between men and woman although
some literature suggests that GIST has a slight male predominance (4).
Although GIST has been documented in patients of all ages, most of the
people affected by GIST are between 40 and 80 years old at the time of
3. 3
diagnosis with the median age of 60 years (5).The proportion of overtly
malignant or high-risk GISTs is considered to be 20-45% of all GISTs
(6), which suggests that the annual incidence of GISTs with a high
malignancy potential is about 5 - 6.8 per million (7). GISTs present as
well circumscribed, highly vascular tumors in the wall of subserosa of the
gastrointestinal tract. On gross examination, these tumors appear fleshy,
pink or tan-white, and may show hemorrhage. Large tumors frequently
show cystic degeneration or necrosis even in the absence of prior
treatment (8). Most GlSTs (60% to 70%) arise in the stomach, 20% to
30% originate in the small intestine, and less than 10% in the esophagus,
colon, and rectum. GISTs can also occur in extra intestinal sites in the
abdomen or pelvis such as the omentum, mesentery or retroperitoneum
(9). The vast majority of studies on GISTs suggest that the two most
important prognostic features to assess the risk of aggressive behavior in
a primary GIST are mitotic activity and tumor size. These two features
were the foundation of the consensus approach for risk assessment in
GISTs (10). According to the new guidelines (11) GISTs smaller than 2
cm without significant mitotic activity (<5 per 50 high-power fields) can
be regarded as essentially benign. The next strongest parameter in these
studies was tumor location, small intestinal and rectal GlSTs were more
aggressive than gastric GlSTs of similar size (12). The clinical
presentation of GIST varies widely, approximately 70% of patients with
GIST were symptomatic, 20% were asymptomatic, and 10% were
detected at autopsy. GISTs that caused symptoms tended to be larger with
an average size of 6 cm. versus 2 cm. for asymptomatic GISTs and 1.5
cm. for GISTs detected at autopsy (13). Total surgical resection still
constitutes the standard treatment for non-metastatic GISTs, since it is the
only modality of treatment capable of being curative. The complete R0
resection (absence of residual disease) represents one of the most
4. 4
important determinant factors in the treatment outcome (disease-free
interval and survival); RO resection is achieved in approximately 40% to
60% of all cases of GIST and in over 70% of the non-metastatic case
(14). The primary goal of surgery is the total resection of the tumor. The
type of resection to be performed is dependent on tumor location and
size. Lesions suspected of having invaded adjacent organs must be treated
by radical surgery through an en bloc resection of the organs involved. It
is mandatory that the resection achieves negative margins verified by
intraoperative frozen section examination, since the presence of residual
disease negatively influences survival (15). The presence of lymph node
metastasis has not been recognized as a prognostic factor (16); in fact, no
data can be found in the literature to support routine lymphadenectomy.
Therefore, lymphadenectomy should be performed when gross
examination suggests lymph node involvement.
For patients presenting with metastatic or recurrent GIST, the exact place
of surgery in the Imatinib era remains to be determined. Surgery is
generally not indicated if a patient presents with generalized disease
progression under treatment. In such situation, the outcomes appear to be
marginal: one study reported no patients free of recurrence at 12 months
(17) and another reported a median time to progression of 3 months (18).
The aim of this study is to correlate the clinicopathologic aspects of
Gastrointestinal Stromal Tumors (GISTs) with surgical resection,
pathological characterestics; disease free survival (DFS) and overall
survival (OS) for all cases in a combined retrospective and prospective
study.
Patient and methods
A retrospective study of 33 patients (January 2001- December 2006), and
5. 5
a prospective study of 34 patients (January 2007 - January 2011) at the
National Cancer Institute, Minia Oncology Center and Fayoum Teaching
Hospital.
All patients were evaluated pre-operatively with complete laboratory
investigations, chest radiograph and CT abdomen and pelvis with oral
and IV contrast. Upper and lower GIT endoscopies were performed when
indicated while an endoscopic biopsy done when the later was feasible.
All patients underwent exploratory laparotomy aiming at complete
surgical resection with a curative intent; they were followed up for
periods ranging between 24 – 60 Months.
All specimens were examined in relation to the risk factors, namely size,
and histopathological grade and safety margin "R status". All specimens
were also subjected to immunohistochemistry staining including CD34
cent CD117, tumors exhibiting mitotic rate 5/50 per high-power field
(HPF) or less were defined as low grade and those exhibiting mitotic rate
> 5/50 HPF as high grade tumors.
Results
Among the 67 patients in the studied population female predominance
was obvious where 25 patients were men (37.3%) and 42 patients were
women (62.7%). The median age was 49.7 years. 15 patients (22.4%)
were under age of 40, 27 patients (40.3%) in the range between 40 and 60
years and 25 patients (37.3%) were above 60 concluding that 77.6% of
the patients were above 40 years old.
All patients were symptomatic on presentation, the most common
symptom was pain in 27 patients (40.3%),other clinical manifestations
included palpable mass in 24 patients (35.8%), GIT bleeding in 22
6. 6
patients (32.8%), Nausea & vomiting in 8 patients (11.9%), Anemia in 17
patients (25.4%) weight loss in 6 patients (9%) and constipation in 5
patients (7.5%).
Computed tomography (CT) of the abdomen and pelvis was the most
commonly used investigation (Figures 1 and 2), being done for 65
patients (97.6%). The other investigations used included upper GI
endoscopy in 17 patients (25%) and lower GI endoscopy used in 11
patients (16.4%).
Endoscopic abnormalities were demonstrated in 14 of 17 patients who
underwent upper GIT endoscopy (82.3%). Those abnormalities were:
extra gastric mass in 10 patients (71%) and ulcerative mass in 4 patients
(29%).As for lower GIT endoscopy, abnormalities were detected in 9 of
the 12 patients in whom it was performed (75%), Detected abnormalities
were: ulcerating and extra luminal mass in 7 patients (77.7%) and 2
patients (22.2%) respectively. FNAC was done in 8 patients only and was
positive diagnosis only in 6 of 8 patients.
Anatomic distribution of the tumors is listed in (Table 1). The most
common site of origin was the stomach (Figure 3) 33 patients (49.3%),
followed by the small intestine (Figure 4 & 5) 19 patients (28.4%), the
colon and rectum 9 patients (13.4%), Mesentery 5 patients (7.5%) and
least frequently abdominal wall 1 patient (1.5%).
Postoperative pathology revealed tumor size more than 5 cm. in 56
patients (83.6%) and less than 5 cm. in 11 patients (16.4%). Tumors
exhibited high histopathologic grade in 47 patients (70.1%) and low
Grade in 20 patients (29.9%). Microscopic examination revealed spindle
cell appearance in 55 patients (82.1%), epithelioid in 5 patients (7.5%)
and mixed in 7 patients (10.4%). Receptor status was studied in most of
cases, CD117 was positive (Figure 7) in 28 cases (41.8 %) and negative
in 12 cases (17.9%), CD34 was positive in 25 cases (37.3%) and negative
7. 7
in 10 cases (14.9%). Actin was done in 20 cases (29.9%) and Desmin in 5
cases (7.5%) all of them were negative (Table 2). The incidence of lymph
node involvement in our series was 0%.
The different operative procedures (Figure 6) performed during this
study are listed in (Table 3). Complete resection with final negative
pathologic margins (R0) was accomplished in 53patients (79.1%) and
incomplete resection either microscopic (R1) or gross (R2) was
documented in 14 patients (20.9%).
Intra-operatively 3 complications (4.4%) were reported in the form of 2
minor bladder injuries (2.9%) due to extensive adhesions and repaired
primarily in 2 layers and a single case (14.9%) of major vascular injury
(aorta) which was repaired. Post-operatively 4 morbidities and 2
mortalities, two cases with wound sepsis, one cysto-cutaneous urinary
fistula, and the fourth patient suffered from malnutrition all cases were
managed conservatively.
Disease free survival (DFS) was calculated from the date of primary
tumor resection to the date of recurrence or the last follow-up date. DFS
and Overall survival (OS) were assessed in relation to the following
variables: size of the tumor (Table 4), grade of the tumor (Table 5) and
completeness of resection (Table 6). Statistical analysis revealed a better
DFS and OS with tumors <5 cm. in diameter, low grade and completely
resected tumors. Cases with tumor size 5 < cm (11 cases) had disease free
survival 45.63+13.46 and overall survival 46.18+12.32 while tumors >
5cm (56 cases) had DFS 25.96+13.29 OS 27.46+11.99. And this
difference was statistically significant (P-Value > 001). Twenty patients
had low-grade tumors whose DFS was 43.55+8.49 and OS 43.95+7.83
while 47 patients had high-grade tumors with a DFS 23.08+13.05 and OS
24.82+11.75 (P-Value < 001). DFS was 33.35+ 13.93 and OS
8. 8
33.77+13.46 in tumors completely resected, while tumors incompletely
resected or with positive margins DFS was 13.42+6.79 and OS
18.28+6.61 (P value <001).
In the prospectively studied 34 patients only 16 patients (47.1%) received
adjuvant therapy 14 patients of them received Imatinib myselate and 2
patients received other chemotherapeutic regimens due to the high cost
and unavailability of Imatinib myselate.
Discussion
GIST represents the most common mesenchymal tumor of the gastro-
intestinal tract, a female predominance in this study representing 62.7%
of patients, however a fairly equal distribution between men and woman
in the literature (19). About 77.6% of patients in our study were above 40
years with a median age of 49.7 years. In comparison to Kim KM et al.
2005, who reported over 90% of GISTs occur in adults over 40 years,
with a median age of 63 years (5).
The symptoms associated with primary gastro-intestinal stromal tumors
are usually vague and nonspecific which is a contributing factor in the
delayed diagnosis associated with GIST (20). Despite the fact that most
patients in our study were symptomatic either with pain, abdominal mass
and/or GIT bleeding .Previous studies report that only 70% of patients are
symptomatic, while 20% are asymptomatic and 10% detected in autopsy
(21). This was explained by the large size of tumors in this study in
comparison to the small size (< 2 cm) of asymptomatic tumors in others
(22).
By analysis of the utility of the frequently ordered diagnostic studies that
9. 9
were performed before surgical exploration, the most frequently ordered
diagnostic test in our series was the CT scan (97.1%) which demonstrated
the mass, determined its size and its relation to contiguous organs and it
confirmed the presence or absence of distant metastases. A primary tumor
is typically a well- circumscribed and often highly vascular mass closely
associated with stomach or intestine .GISTs usually appear heterogeneous
due to necrosis or intramural hemorrhage. Upper GIT endoscopy to
evaluate a patient with upper gastrointestinal bleeding seems a reasonable
first test to detect a benign source but it was our general impression that
these studies added little in terms of planning the extent and the type of
the operation because most of the endoscopically detected lesions were
extra-luminal with an intact mucosa. Needle biopsy was performed
infrequently and, when performed, was not helpful in the establishment of
a definitive diagnosis. No other imaging tests (including upper
gastrointestinal contrast study or abdominal ultrasound scanning) were
found to be more sensitive than CT for the detection and staging of a
primary GIST.
In this study, tumors originated most frequently from the stomach 49.3%,
these finding are similar to other reports in which the stomach was
involved in 38% to 65% of cases (4, 23, 24). The small intestine was the
second most common site of origin representing 28.4% correlating with
other reports in which the small intestine represents about 30% of tumor
origin (4).
Regarding the size of the primary GISTs in this study, 83.6% of patients
had tumors greater than 5 cm and 16.4% had tumors less than 5 cm. This
was explained by the latent period between the start of disease and
initiation of symptoms and delay for seeking a medical advice. Small
tumors (< 5 cm.) had a significantly better DFS and OS. Similarly,
10. 10
several studies demonstrated that tumor size more than 5 cm significantly
affect survival (24) where the 5 –years DFS rate for patients with primary
tumor < 5 cm was 95% (52.1-100) ,5-10 cm 31.2% (16.6-42.8) and > 10
cm 22.5% (11.5-33.6).
As with sarcomas elsewhere, histological grade is a powerful prognostic
characteristic. Previous Reports have shown that low grade lesions are
associated with improved overall 5-year survival in the 40% to 80%
range compared with high-grade lesions with overall survival rates
between 16% and 28% (25), and this correlates with our study where
significant better DFS and OS were detected in low grade tumors.
In the current study, Spindle cell tumors represented 82.1% of all cases,
epithelioid cell type 7.5 % and Mixed type 10.5 % which are close to
percentages to many studies (26), however Miettinen et al 2006 stated
that spindle cell GISTs represent approximately 70%, epithelioid GISTs
20% and mixed spindle and epithelioid cyto-morphology approximately
10% (8).
Characteristically stain positively for CD117 and CD34, but less
commonly for Actin and Desmin which are expressed typically by
leiomyosarcoma and shwanomas, respectively (20). In our study, about
79% of patients were positive for CD117 and CD34 Compared to other
studies which reported positive CD 117 in 85-94% (27) and positive
CD34 in 52-72% of cases (28).
Complete surgical resection emerged as the most important prognostic
variable in this study. Complete resection were achieved in 79.1% of
patients and residual disease either microscopic or gross were in 20.9%;
similarly Jason S et al 2006 achieved complete resection in 80% of cases
11. 11
(29). In a recent report, Langer et al., 2003 reported the outcome of 39
patients following surgery. Complete (R0) resection was achieved in 35
of 39 patients and from whom only five died from recurrent disease,
compared with 3 of 4 patients with involved margins (30). Incomplete
resection should only be performed for palliation of pain, bleeding or
symptoms due to mass effect.
Univariate analysis of different studies of GIST found that tumor size of
less than 5cm, low histological grade, presence of localized disease, and
complete surgical resection without tumor spillage were all favor-able
prognostic factors (31).
The incidence of lymph node involvement in our series was 0%, which is
consistent with a low incidence of lymph node metastases seen in other
reports (less than 2%) (32).
In conclusion complete resection with an aggressive attempt to remove all
gross disease and achieve negative margins remains the fundamental
surgical principle in the management of GIST. Extensive preoperative
testing and biopsy do little and not recommended; still CT is the best
modality for evaluation of GIST. For localized gastric tumors, wedge
resection with negative margins appears adequate. More extensive gastric
lesions may require total gastrectomy or en bloc resection of adjacent
organs. Small bowel and colon lesions are removed with segmental
resections and, when indicated, may require the removal of involved
contiguous organs. As the incidence of lymph node involvement is low,
extended lymph node dissections are not warranted.
12. 12
References
1) Gina D; Dejka MS; John CM; Jonathan CT. Update on the
biology and therapy of gastrointestinal stromal tumors, cancer
control. 2005; 12(1): 44-56.
2) Joensuu H: Gastrointestinal Stromal tumor (GIST). Annals of
oncology 2006, 17 (10):280 -286.
3) Heinrich MC, Corless CL, Duensing A,et al: PDGFRA activating
mutations in gastrointestinal stromal tumors. Science 2003,
299:708-710.
4) Dematteo RP, Lewis JJ, Leung D, et al. Two hundred
gastrointestinal stromal tumors: recurrence patterns and prognostic
factors for survival. Ann Surg 2000:231 (1):51-8.
5) Kim KM, Kang DW, Moon WS: Gastrointestinal stromal tumor
committee; The Korean Gastrointestinal pathology study Group.
Gastrointestinal stromal Tumors in Koreans: incidence and the
clinical, pathologic and immune-histochemical findings. J Korean
Med sci 2005, 20:977-984.
6) Nilsson B, Bumming P, Meis- Kindblom JM, et al.
Gastrointestinal stromal tumors: The incidence, prevalence, clinical
course, and prognostication in the pre-imatinib mesylate era,
Cancer 2005, 103(4) 821-29.
7) Tran T, Davila JA, EL-Serag HB. The epidemiology of malignant
gastrointestinal stromal tumors: an analysis of 1,458 cases
from1992 to 2000.AM J Gastroenterol 2005, 100(1), 162-8.
8) Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on
morphology, molecular pathology, prognosis, and differential
diagnosis, Arch Pathol Lab Med 2006; 130(10):1466-78.
9) De silva CM, Reid R. Gastrointestinal stromal tumours (GIST): C-
kit mutations, CD117 expression, differential diagnosis and
13. 13
targeted cancer therapy with imatinib. Pathol Oncol Res.2003;
9:13-19.
10) Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J,
Longley BJ et al. Diagnosis of gastrointestinal stromal tumors: A
consensus approach. Hum Pathol. 2002 May; 33(5):459-65.
11) Demetri GD, Benjamin RS, Blanke CD, et al. NCCN Task
Force report: management of patients with gastrointestinal stromal
tumor (GIST) update of the NCCN clinical practice guidelines. J
Natl Compr Canc Netw 2007; 5(Suppl2): S1-29(quiz S30).
12) Miettinen M, Makhlout H, Sobin LH, et al. Gastroll
iteslinal stromal tumors of the jejunum and ileum: a
clinicopathologic, immunohistochemical, and molecular genetic
study of 906cases before Imatinib with long – term follow-up. Am
J surg Pathol 2006; 30(4):477-89.
13) Kindblom LG. Gastrointestinal stromal Tumors; Diagnosis,
Epidemiology, Prognosis. ASCO Annual Meeting Chicago II,
2003.
14) Roberts PJ, Eisenberg B. Clinical presentation of
gastrointestinal stromal tumors and treatment of operable disease.
Eur J Cancer. 2002; 38 suppl 5:537-8.
15) Singer S, Rubin BP, Lux ML, et al. Prognostic value of KIT
mutation type, mitotic activity, and histologic subtype in
gastrointestinal stromal tumors. J Clin oncol. 2002; 20(18):3898-
905.
16) Valadao M, de Mello EL, Lourenco L, et al. What is the
prognificance of metastatic lymph nodes in GIST?
Hepatogastroenterology. 2008; 55(82-83):471-4.
17) Raut C, Posner M, Desai J, et al. Surgical management of
advanced gastrointestinal stromal tumors after treatment with
14. 14
targeted systemic therapy using kinase inhibitors. J Clin
Oncol.2006; 24(15):2325-2331.
18) Dematteo R, Maki R, Singer S, Gonen M, Brennan M,
Antonescu CR. Results of tyrosine kinase inhibitor therapy
followed by surgical resection for metastatic gastrointestinal
stromal tumor. Ann Surg. 2007; 245(3):347-352.
19) Goettsch WG, Bos SD, Breekveldt-Postma et al. Incidence
of gastrointestinal stromal tumours is underestimated: Results of a
nation – wide study. Eur J Cancer, 2005, 14(18), 2868-72.
20) Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S.
Gastrointestinal stromal tumor: consistent CD117 immunostaining
for diagnosis, and prognostic classification based on tumor size and
MIB-1 grade. Hum Pathol. 2002 33:669-76.
21) Heinrich MC, Corless CL, Demetri GD, et al. kinase
mutations and Imatinib response in patients with metastatic
gastrointestinal stromal tumor. J clin oncol 2003:21(23):4342-9.
22) Nilsson B, Bumming P, Meis- Kindblom JM, et al.
Gastrointestinal stromal tumors: The incidence, prevalence, clinical
course, and prognostication in the pre-imatinib mesylate era,
Cancer 2005, 103(4) 821-29.
23) McGrath PC, Neifeld JP, Lawerence w, Kay S, Horsley Js,
paker GA, Gastrointestinal sarcomas: Analysis of prognostics .
Ann Surg. 1987, 206: 706-10.
24) Dougherty MJ, Compton C, Talbert M, wood WC.
Sarcomas of the gastrointestinal tract: separation into favourable
and unfavourable prognostic groups by mitotic count, Ann Surg.
1991. 214: 569- 74.
25) Meijer S. Peretz T. Gaynor JJ, Tan C, Hajdu St, brennan
MF. Primary colorectal sarcoma. Arch Surg. 1990, 125: 1163-68.
15. 15
26) Ting WU, LI YU, Chun NE et al :Surgical and treatment
and prognostic analysis for ( GISTs) of small intestine ; before the
era of Imatinib ;B M Gastroenterolgy 2006,6 :29.
27) Hirota S; Isozaki K. Pathology of gastrointestinal stromal
tumors. Pathol int. 2006; 56 (1): 1-9.
28) Miettinen M, Monihan JM, Sarlomo-Rikala M, et al.
Gastrointestinal stromal tumors/smooth muscle tumors (GISTs)
primary in the omentum and mesentery: clinicopathologic and
immunohistochemical study of 26 cases. Am J Surg Pathol 1999;
23:1109-1118.
29) Jason S, Ronald P, DeMatteo et al: Combined surgical and
Molecular Therapy; Ann Surg; 2006 August; 244(2):176-184.
30) Langer C, Gunawan B, Schulter P, Huber W, Fuzesi L,
Becker H. Prognostic factors influencing surgical management and
outcome of gastrointestinal stromal tumors. Br J surg.2003,
90:332-39.
31) Heikki Joensuu. Risk stratification of patients with
gastrointestinal stromal tumors .Human Patholgy 2008: volume 39,
Issue 10, pages 1411-1419.
32) Burkill GJ, Badran M, Al-Muderis O, Thomas JM, Judson
IR, Fisher C, et al, Malignant gastrointestinal stromal tumor:
Distribution, imaging features and pattern of metastatic spread.
Radiology. 2003,226:527-32.
16. 16
Figure (1): CT abdomen axial cut for gastric GIST
Figure (2): CT abdomen sagittal cut for jejunal GIST
Figure (3): Small exophytic gastric GIST from the anterior wall of the stomach.
21. 21
Right hemicolectomy. 2 3
Transverse colectomy. 1 1.5
Cystic mass excision + pancreatectomy. 1 1.5
Huge mass excision + partial cystectomy. 1 1.5
Excision of mass of abdominal wall +
prolene mesh
1 1.5
Mesenteric mass en block resection with
transverse colectomy.
1 1.5
Table (4): Effect of size on DFS and OS
Less than 5 cm More than 5 cm P value
Disease free
survival
45.63 ± 13.46 25.96 ± 13.29 <0.001
Overall survival 46.18 ± 12.32 27.46 ± 11.99 <0.001
Table (5): Effect of tumor grade on DFS and OS
Low grade High grade P value
Disease free
survival
43.55 ± 8.49 23.08 ± 13.05 <0.001
Overall survival 43.95 ± 7.83 24.82 ± 11.75 <0.001
22. 22
Table (6): Effect of completeness of resection on DFS and OS
R0 R1&2 P value
Disease free
survival
33.35 ± 13.93 13.42 ± 6.79 <0.001
Overall survival 33.77 ± 13.46 18.28 ± 6.61 <0.001