title: Cutaneous and subcutaneous metastases of gastrointestinal stromal tumors: a series of 5 cases with molecular analysis.
abstract: Gastrointestinal stromal tumors (GISTs) rarely metastasize to the skin. We describe 5 patients with GIST with subcutaneous and cutaneous metastases. The mean age at metastasis was 54 years (range 30-68 years) with a male predominance (4:1). Primary tumors occurred in the stomach (n = 3), small bowel (n = 1), and abdomen, not otherwise specified (n = 1). The average time from primary tumor resection to the resection of skin metastases was 59 months (range 11-155 months). The metastases occurred in the scalp (n = 2), cheek (n = 1), and abdomen (n = 2) with 3 patients presenting with solitary nodules and 2 patients with multiple nodules. The average size was 2 cm (range 0.6-4 cm). Histologically, 2 cases were spindled and 3 cases demonstrated mixed epithelioid and spindle cell morphology. All were confirmed to have CD117 reactivity. KIT genotyping was performed in 4 of 5 cases. Two cases harbored a mutation in exon 11, and the remaining 2 cases were wild type in exons 9, 11, 13, and 17. All 5 patients had multiple concurrent or subsequent abdominal and/or hepatic metastases. In 4 patients with an average follow-up of 32 months (range 6-75 months), after the resection of the metastases, 2 were alive with disease and 2 died of disease. Cutaneous metastases seem to be a late complication of GIST, but their presence does not necessarily herald a rapid demise of the patient.
authors.affiliation: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors.forename: Wei-Lien
authors.initials: WL
authors.lastname: Wang
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.forename: Raj
authors.initials: R
authors.lastname: Mallipeddi
authors.forename: Bettina G
authors.initials: BG
authors.lastname: Zelger
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Rother
authors.forename: Dan
authors.initials: D
authors.lastname: Yang
authors.forename: Dina C
authors.initials: DC
authors.lastname: Lev
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Trent
authors.forename: Victor G
authors.initials: VG
authors.lastname: Prieto
authors.forename: Thomas
authors.initials: T
authors.lastname: Brenn
authors.forename: Alistair
authors.initials: A
authors.lastname: Robson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Calonje
authors.forename: Alexander J F
authors.initials: AJ
authors.lastname: Lazar
mesh_terms: D000328:Adult; D000368:Aged; D004252:DNA Mutational Analysis; D005091:Exons; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009154:Mutation; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis / Q000235:genetics; D012878:Skin Neoplasms / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D040521:Subcutaneous Tissue / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019009:Proto-Oncogene Proteins c-kit