Clinical and molecular characteristics of pediatric gastrointestinal stromal tumors (GISTs).
BACKGROUND
To describe the clinical characteristics, molecular features, treatment, and outcome of six pediatric patients with gastrointestinal stromal tumors (GISTs).


METHODS
Retrospective clinical review of GISTs, seen at The Hospital for Sick Children (HSC) Toronto, over an 11-year period. All specimens were stained for the CD 117 and CD 34 antigens. Three specimens were sequenced for mutations in exons 9, 11, and 13 of the c-kit gene.


RESULTS
Five patients were evaluated and treated at HSC and one was referred for histopathological consultation only. The median patient age at diagnosis was 13.6 years, (6.9-14.8 years); four were female. All patients presented with anemia secondary to gastrointestinal (GI) bleeding. The disease was localized in five patients and two had other malignancies consistent with the diagnoses of Carney's triad. Immunohistochemical staining for CD 117 and CD 34 showed heavy cytoplasmic localization in all of the tumor cells. A novel point mutation of KIT in codon 456 of exon 9 was found in one case. Complete surgical resection was achieved in the five patients managed at our center and none received adjuvant therapies. Disease recurred locally in one patient. Four patients are alive and one is lost to follow-up.


CONCLUSIONS
In children and adolescents, GISTs should be considered in the differential diagnosis of anemia secondary to GI hemorrhage. The absence of an exon 11 mutation and the identification of a novel mutation in exon 9 suggest that pediatric GISTs may respond differently to currently available targeted therapies and therefore should be studied within the context of collaborative group trials.
Price
Victoria E
VE
Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto.
Zielenska
Maria
M
Chilton-MacNeill
Susan
S
Smith
Charles R
CR
Pappo
Alberto S
AS
D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D002648:Child; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000235:genetics* / Q000473:pathology*; D006801:Humans; D008297:Male; D017354:Point Mutation; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*; D012189:Retrospective Studies
D019009:Proto-Oncogene Proteins c-kit