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A 62-year-old man with anemia and chronic weight loss (A) Axial precontrast CT abdomen shows combination of intraluminal and extraluminal mass with irregular and smooth border jejunum (white arrow) (B) Axial portovenous phase CT abdomen shows inhomogeneous enhancement of the lesion with intratumoral fluid (black arrow)
Source publication
To describe anatomical distribution and CT findings of gastrointestinal stromal tumors in Srinagarind Hospital.
The abdominal CT images of 16 patients (12 men, 4 women: mean age 49 +/- 17SD) with pathologically proven GISTs during 1998-2005 were retrospectively reviewed. The tumor sites, sizes, borders, growth patterns, patterns of enhancement, and...
Contexts in source publication
Context 1
... was high level of agreement [87.97% (43.52-100 of 95% confidential interval)] in identifying the origin of the lesion on the CT finding and patho- logic report. The tumor location were stomach (n = 9, 56.25%) (Fig. 1), small bowel (n = 7, 43.75%) (Fig. 2). CT scans of all tumors were larger than 5 cm in size. Half of all tumors had smooth margins. The growth patterns were identified as extraluminal in nine patients (56.25%) (Fig. 1). The remaining 43.75% had extraluminal combined with intraluminal growth pattern (Fig. 2). Precontrast CT scans of almost all GISTS had inhomogeneous ...
Context 2
... location were stomach (n = 9, 56.25%) (Fig. 1), small bowel (n = 7, 43.75%) (Fig. 2). CT scans of all tumors were larger than 5 cm in size. Half of all tumors had smooth margins. The growth patterns were identified as extraluminal in nine patients (56.25%) (Fig. 1). The remaining 43.75% had extraluminal combined with intraluminal growth pattern (Fig. 2). Precontrast CT scans of almost all GISTS had inhomogeneous density (n = 15, 93.75%) (Fig. 1). Seven tumors contained intratumoral gas (43.75%), 6 contained intratumoral fluid (37.5%), and 8 contained intratumoral calcification (50%) (Fig. 1). Only one case (6.25%) had homogeneous hypodensity. All tumors had inhomogeneous contrast ...
Context 3
... 2). Precontrast CT scans of almost all GISTS had inhomogeneous density (n = 15, 93.75%) (Fig. 1). Seven tumors contained intratumoral gas (43.75%), 6 contained intratumoral fluid (37.5%), and 8 contained intratumoral calcification (50%) (Fig. 1). Only one case (6.25%) had homogeneous hypodensity. All tumors had inhomogeneous contrast enhancement (Fig. 2). Three patients were identified as the benign or low grade GISTs and five patients were classified as malignant GISTs in the pathologic report. The remaining eight patients who were not documented as malignant or benign in pathologic report were treated with KIT tyrosine kinase inhibitor so they were presumed to be malignant ...
Citations
... Focal calci cation within GIST has been reported, ranging from 10-50% in reported series. 3,4,5 However, extensive thick calci cation is a rare phenomenon. 1 ...
Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumour of gastrointestinal tract and the stomach being the most commonly involved organ. Focal calcification may be seen in GIST but prominent or heavy calcification is rare. Gastric mass with prominent calcification on imaging may create a diagnostic dilemma. We present a rare case of gastric GIST with heavy calcification in a 55 years old female presenting with abdominal lump. Computed tomography (CT) showed a large heterogenous juxta gastric mass with solid-cystic component with heavy calcification. She underwent laparotomy and en-bloc gastric sleeve resection with the mass. Microscopic examination showed tumour with spindle cell and calcification with mitotic index of 6/50 High power field. Immunoreactivity with Vimentin, CD34 and DOG 1 confirmed diagnosis of GIST. Dystrophic calcification of necrotic or degenerative tissue is thought to be cause of calcification in GIST. Very few cases of heavily calcified GIST have been reported in literature, our case is of interest because presence of solid cystic component and a huge size ~ 14 cm (longest diameter).
... In the past, some researchers have used MR DWI technology to evaluate the efficacy of targeted therapy for GIST, and some researchers have also used DWI and DCE-MR to predict the survival of patients with GIST metastasis [12,13]. Some researchers have found that GIST risk classification may not be reliable when based on the findings of conventional CT and MR, such as tumor size [14,15]. Therefore, it is necessary to comprehensively consider the shape, location, volume, signal and blood supply characteristics of GIST with different degrees of risk, and to make a quantitative analysis based on these factors. ...
Background
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. At present, it is generally believed that the prognosis of GIST is closely related to its risk classification. It may add value to correctly diagnose and evaluate the risk of invasion using a noninvasive imaging examination prior to surgery. MRI has the advantages of multiple parameters and high soft tissue resolution, which may be the potential method to preoperatively evaluate the risk of GIST.
Purpose
To retrospectively evaluate the diagnostic accuracy of multi-parameter MR analysis for preoperative risk classification of GIST.
Materials and methods
In this 6-year retrospective study, full MRI examination was performed on all 60 GIST cases confirmed classified by pathology, including 35 cases of very low-to-low-risk GIST and 25 cases of intermediate-to-high-risk GIST. Dynamic contrast-enhanced T1- and T2-weighted images, and apparent diffusion coefficient (ADC) maps were reviewed independently by two radiologists blinded to pathologic results. Volume, ADC ratio, three wash-in indexes (WII) were calculated and compared using t-test or Kruskal–Wallis nonparametric test. Sensitivity and specificity analyses were performed to calculate diagnostic accuracy using ROC analyses. Differences were considered significant at p < 0.05.
Results
All GISTs were resected. Patient age, sex, tumor location and tumor shape did not differ significantly across the two groups (p = 0.798, 0.767, 0.822 and 0.096, respectively). GIST in the intermediate-to-high-risk group presented significantly greater volume (p = 0.0045), lower ADC ratio (p = 0.0125) and faster enhancement (for WII2, p < 0.0001; for WII3, p = 0.0358) than that of GIST in the very low-to-low-risk group. This combination of the volume, ADC ratio and WII2 provided sensitivity of 88%, specificity of 94.29%, and accuracy of 91.7% for the risk classification of GIST.
Conclusion
Multi-parameter MR analysis provides a preoperative imaging standard for accurately distinguishing very low-to-low-risk GIST from intermediate-to-high-risk GIST.
... Whereas computed tomography (CT) is widely used in the identification and localization of tumors, it has proven to be of limited value in the evaluation of esophageal SMTs [12][13][14][15][16][17][18]. Normally, the esophagus contains little air, and this lack of contrast makes it difficult to distinguish esophageal SMTs from the esophageal wall and the surrounding tissues. ...
Background
The selection of therapy for benign esophageal lesions depends in part on whether the lesion extends to or through the esophageal muscle wall. The advent of endoscopic dissection of deep lesions has made this distinction important in the choice between different forms of advanced endoscopic therapy. The goal of this study was to evaluate esophageal insufflation computed tomography (EICT) for the diagnosis and management of esophageal submucosal tumors (SMTs). Methods
Between April 2011 and May 2013 at the Second Affiliated Hospital of Harbin Medical University, 27 patients with esophageal SMTs diagnosed by gastroscopy were studied observationally. Entry criteria included tumors larger than 0.5 cm. We compared endoscopic ultrasound (EUS) and EICT to assess lesion depth and the relationship between the submucosal lesion and the esophageal wall using the resected lesion as the gold standard. ResultsTwenty-seven esophageal SMTs were evaluated. EUS and EICT accurately identified nine as superficial to the muscularis propria. EICT correctly identified the relation of the tumor extension and the outer esophageal wall in all 18 lesions that originated from the muscularis propria; only nine were correctly assessed by EUS (P < 0.001). ConclusionsEICT enables improved judgment of the relation of esophageal lesions and the esophageal-mediastinal border. We propose EICT as a new, safe, effective, useful, simple and high-tolerance method for assessing the depth and relationships of esophageal submucosal lesions.
... The lack of specific clinical manifestations and the location of the tumors make the diagnosis difficult. Routine diagnostic imaging modalities mainly consist of endoscopic examination, computed tomography (CT) scanning, and magnetic resonance imaging (MRI) [7][8][9][10][11][12] . However, doctors who admit patients with acute or subacute obscure gastrointestinal bleeding (OGIB) prefer to conduct emergency interventional digital subtraction angiography (DSA), whereas some routine exams are not able to identify the bleeding [13][14][15] . ...
... Compared with the findings of Fang et al [17] , which showed that draining veins were found only in 27.2% (3/11) of these tumors, we think that the different appearances of the draining veins are mainly based on tumor location, size, and classification. Although CT scans [2,[9][10][11]13,17] also focus on the detection of feeding arteries and tumor blood supply, little attention has been paid to the draining veins of GISTs. In this study, in addition to the clear depiction of feeding arteries, numerous draining veins on tumors also appeared clearly in the early phase of the DSA procedures. ...
... We think that this feature may be used as one of the angiographic criterion for small intestinal GISTs and can be used to detect and localize smaller GISTs (especially ≤ 2 cm in our study). In addition, two reasons that the small bowel GISTs were relatively smaller compared with previous reports [1,10,11,14] include tumor bleeding and the timely use of the DSA procedure. Furthermore, to our knowledge, this article presents the largest DSA series of small bowel GISTs to date [13,[17][18][19][20] . ...
To retrospectively evaluate the diagnostic efficacy of interventional digital subtraction angiography (DSA) for bleeding small bowel gastrointestinal stromal tumors (GISTs).
Between January 2006 and December 2013, small bowel tumors in 25 consecutive patients undergoing emergency interventional DSA were histopathologically confirmed as GIST after surgical resection. The medical records of these patients and the effects of interventional DSA and the presentation and management of the condition were retrospectively reviewed.
Of the 25 patients with an age range from 34- to 70-year-old (mean: 54 ± 12 years), 8 were male and 17 were female. Obscure gastrointestinal bleeding, including tarry or bloody stool and intermittent melena, was observed in all cases, and one case also involved hematemesis. Nineteen patients required acute blood transfusion. There were a total of 28 small bowel tumors detected by DSA. Among these, 20 were located in the jejunum and 8 were located in the ileum. The DSA characteristics of the GISTs included a hypervascular mass of well-defined, homogeneous enhancement and early developed draining veins. One case involved a complication of intussusception of the small intestine that was discovered during surgery. No pseudoaneurysms, arteriovenous malformations or fistulae, or arterial rupture were observed. The completely excised size was approximately 1.20 to 5.50 cm (mean: 3.05 ± 1.25 cm) in maximum diameter based on measurements after the resection. There were ulcerations (n = 8), erosions (n = 10), hyperemia and edema (n = 10) on the intra-luminal side of the tumors. Eight tumors in patients with a large amount of blood loss were treated with transcatheter arterial embolization with gelfoam particles during interventional DSA.
Emergency interventional DSA is a useful imaging option for locating and diagnosing small bowel GISTs in patients with bleeding, and is an effective treatment modality.
... Necrosis, calcification, and ulceration are most commonly seen in large tumors that present a more aggressive behavior [6]. Focal calcification within GIST has been reported, ranging from 10% to 50% in reported series678 . However , extensive thick calcification visible on plain radiograph is a rare phenomenon [1,8]. ...
Thick calcification is a rare presentation of gastrointestinal stromal tumor (GIST). Penetration into gastric mucosa and pericolic soft tissue has never been reported. We report a case of gastric GIST with cystic degeneration and thick calcification in an 81-year old female, who presented with hematemesis and severe abdominal pain. Thick calcification of this tumor penetrating into pericolic soft tissue was noted and successfully treated by distal gastrectomy and partial colectomy. For gastrointestinal tumors with thick calcification, even with benign behavior, surgical intervention should be considered for both oncological considerations and prevention of catastrophes like perforation or penetration into surrounding soft tissue.
Gastrointestinal stromal tumors (GIST) are the most common non-epithelial tumors. In recent years, the development of imaging technology has resulted in an increase in diagnostic yield of GIST. In this article, we will review the recent advances in imaging diagnosis of GIST.
To characterize the CT features and to identify predictors of malignancy from CT of GISTs.
A retrospective review of CT images of 50 patients with pathologically and immunohistochemically proven GISTs was done by two radiologists and final interpretations were reached by consensus. Images were evaluated for site, size, contour boundary, growth pattern, enhancement pattern, degree of enhancement, necrosis, calcification, ulceration, perilesionalfat stranding, evidence ofbowel obstruction, and signs of malignancy. Categorical variables were compared using Fisher's exact test and continuous variables used the t-test. Univariate and multivariate logistic regression models were used to identify significant predictors ofa high mitotic rate.
Of the 50 patients, the most common location of GISTs was stomach (62%) The mean size was 10.2 cm (SD 5.2 cm). The contour was lobulated in 84%. The boundary was smooth in 84%. The growth pattern was exophytic in 68%. Most of tumors had heterogeneous density on post-contrast images (88%). Necrosis (84%), calcification (14%), ulceration (40%), perilesionalfat stranding (44%), and bowel obstruction (2%) were present in the tumors. The CT signs of malignancy found were adjacent organ invasion (18%), ascites (18%), lymphadenopathy (6%), liver metastasis (20%), andperitoneal seeding (16%). Necrosis and peritoneal seeding were statistically significant independent predictors for high mitotic GISTs in multivariate logistic regression (p<0.05). The probability of a high mitotic rate was 1 (95% CI, 0.40-1.00) in the presence of both necrosis and peritoneal seeding.
The stomach was the most common site of GIST The CT features of GIST were lobulated, smooth tumor margins, exophytic growth pattern, and heterogeneous enhancement on post-contrast CT images. Presence of both necrosis and peritoneal seeding were found to be a significant predictor of high mitotic rate of GISTs. The probability of a high mitotic rate was 1 (95% CI, 0.40-1.00).
Multiple primary gastrointestinal stromal tumors (GIST) are an infrequent finding. Benign and malignant tumors could coexist in the same patient. We discuss one case of a benign jejunal GIST and a malignant ileal GIST coexisting in the same patient and present their radiological characteristics.
Objective
In this pictorial essay, we described the clinical, pathologic, and computed tomographic (CT) findings of malignant gastrointestinal stromal tumors (MGISTs) and attempt to establish the correlation between radiologic appearance and malignant potential.
Methods
This retrospective analysis included 20 patients receiving treatment for MGIST between 2008 and 2010. The diagnosis was established by pathology and immunohistochemistry. All these patients underwent preoperative CT. Clinical presentation, pathology and CT images were analyzed. Helical CT images were reviewed for morphologic features such as tumor size, number and location, tumor margins, necrosis, degree of enhancement and metastasis.
Results
Gastrointestinal bleeding, abdominal pain and discomfort, and without clinical symptom were common findings and were observed in 9 (45%), 6 (30%), and 5 (25%) of the 20 patients. 8 (40%) tumors were located in stomach, and 10 (50%), 1 (5%) and 1 (5%) were located in small intestine, mesentery and peritoneum, respectively. Male to female ratio was about 1:2. The size of MGIST ranged from 2.6 cm to 17.5 cm with a mean of 8.7 cm. All tumors density was inhomogeneous and heterogeneous enhancement. MGISTs with highly malignant located in small intestine were about 30% higher than stomach. The “satellite” tumours were found in 6 cases with high malignant risk. 7 cases were suffered from liver metastasis, and 4 cases went with seeding into the abdominal cavity, 1 cases went with lymph node metastasis. Histologically, 19 cases (95%) were of spindle cell type. Immunohistochemical stains demonstrated a strong positivity for both c-kit (CD117) and CD34s enhancement in 19 (95%).
Conclusion
Clinical expression is varied in MGIST patients. Female might be predominance in MGIST. The GISTs located in small intestine would tend to be more aggressive. The satellite tumours, necrosis and cystic degeneration were strongly benefit for MGIST diagnosis. Furthermore, intestinal obstruction doesn’t support the diagnosis. Lymph node metastasis and calcification is rare.
