Surgical treatment of gastrointestinal stromal tumor in the esophagus: report of three cases.
OBJECTIVE
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the alimentary tract. The term GIST was introduced in 2004 and understanding of the tumor's cellular origin, classification, diagnostic markers, and prognostic parameters has evolved dramatically over the last two decades. Hirota et al. proposed that GISTs originate from interstitial cells of Cajal - regulators of gut peristalsis that normally express CD 117 - which is the product of the c-kit proto-oncogene that encodes a tyrosine kinase receptor that regulates cellular proliferation in GISTs. In the esophagus, squamous cell carcinoma and adenocarcinoma are common malignant tumors and leiomyoma is the most frequent mesenchymal neoplasm. Esophageal GISTs, however, have been reported less frequently.


METHODS
We report three cases of esophageal GISTs in patients who underwent surgical intervention in our institution. The patients suffered from dysphagia, without specific findings on initial physical examination. Submucosal tumors were suspected after the patients underwent barium swallow and endoscopic studies. In addition, positron emission tomography was used to study a submucosal tumor in one patient.


RESULTS
The pathological diagnosis was confirmed in all cases by microscopic examination with hematoxylin and eosin stain and positive immunoreaction for c-kit. Two of them were low risk and the third one was high risk in character, according to the consensus approach and depending on the size and mitotic index of the tumor.


CONCLUSIONS
The patients had uneventful postoperative recoveries and were followed up regularly at 3-month intervals.
Fang
F-C
FC
Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R. O. C.
Tzao
C
C
Cheng
Y-L
YL
Chan
D-C
DC
Nieh
S
S
Lee
S-C
SC
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D003680:Deglutition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004947:Esophagus / Q000473:pathology; D005629:Frozen Sections; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008940:Mitotic Index; D011379:Prognosis; D000090063:Proto-Oncogene Mas; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; C000715470:MAS1 protein, human; D000090063:Proto-Oncogene Mas; D019009:Proto-Oncogene Proteins c-kit