title: Gastrointestinal stromal tumors: diagnosis and treatment.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the digestive tract. They originate from the interstitial cells of Cajal and are characterized by the overexpression of KIT protein (tyrosine kinase). Their prognosis has improved significantly with the discovery of imatinib mesylate for advanced GIST treatment.
  
  
  METHODS
  We carried out a retrospective, descriptive study of GISTs diagnosed in our center during the past 5 years. We excluded patients with incidental diagnoses in the context of other pathologies because GIST did not affect outcome or prognosis. The variables studied were clinical characteristics, location, size, imaging techniques, resectability, neoadjuvant imatinib, surgical technique, histology, immunohistochemistry, prognostic classification of Fletcher, morbidity, monitoring, and disease-free and overall survival.
  
  
  RESULTS
  Nineteen patients were diagnosed (14 males/5 females) with a mean age of 63 years (range: 30-84 years). Diagnosis was incidental in eight patients (42%). Tumor location of the remaining 11 patients (58%) was six tumors of the small intestine (55%), four gastric (36%) and one rectal (9%). Predominant gastrointestinal bleeding and anemia were diagnosed mainly by abdominal computed tomography (CT). At diagnosis, nine patients were considered resectable with radical intent (82%) and the other two patients (18%) received neoadjuvant treatment with a favorable response after 6 months. Three patients were treated with imatinib after surgery (33%). Median survival was 34 months (range: 5-58 months).
  
  
  CONCLUSIONS
  Diagnosis of GIST is often incidental. The predominant clinical symptom is usually gastrointestinal bleeding and anemia and the most widely used imaging test is CT. Treatment is surgical unless advanced GIST is diagnosed, which will be treated with imatinib mesylate neoadjuvant therapy. A multidisciplinary approach to this pathology is essential, a fact that affects prognosis and patient survival.
authors.affiliation: Cirugia General y de Aparato Digestivo, Hospital Universitario de Fuenlabrada, Madrid, Spain. abumessina@hotmail.com
authors.forename: Débora
authors.initials: D
authors.lastname: Acín-Gándara
authors.forename: Fernando
authors.initials: F
authors.lastname: Pereira-Pérez
authors.forename: Angel
authors.initials: A
authors.lastname: Castaño-Pascual
authors.forename: Manuel
authors.initials: M
authors.lastname: Durán-Poveda
authors.forename: Alfonso
authors.initials: A
authors.lastname: Antequera-Pérez
authors.forename: Carlos
authors.initials: C
authors.lastname: Miliani-Molina
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides; D014408:Biomarkers, Tumor / Q000032:analysis; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000601:surgery*; D006552:Hernia, Inguinal / Q000150:complications; D006801:Humans; D000068877:Imatinib Mesylate; D033162:Incidental Findings; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D014408:Biomarkers, Tumor; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate