title: Gastrointestinal stromal tumors - a clinical-morphological study on 15 cases.
abstract: OBJECTIVE
  The authors present their experience in addressing the gastrointestinal stromal tumors (GIST).
  
  
  METHODS
  15 GISTs operated in the last five years (2008-2013) were analyzed.
  
  
  RESULTS
  The preoperative diagnosis was difficult: established by clinical examination and CT in two cases; imagistic accidental discovery in four cases and revealed by evolving complications in nine cases (gastrointestinal bleeding in four cases and bowel obstruction in five cases). CT may be useful in the preliminary estimation of the tumor extent. Tumor location was: stomach four, duodenum one, small bowel seven, and colon three. Pathological examination set the main criteria for assessing the risk of recurrence and indication for adjuvant therapy: the tumor size, the histological type (spindle cell nine, epithelioid four, and mixed two) and the mitosis rate, while the immunohistochemistry examination established the correct diagnosis (positivity for CD117 and CD34) and criteria of aggressiveness (positivity for Ki67). All cases were operated, the surgical procedure being chosen according to the tumor location and stage. Adjuvant therapy with Imatinib 400 mg/day was performed in the 12 cases with high risk of recurrence. The therapeutic outcome was: a postoperative morbidity rate of 13.3%, four patients cured, one local recurrence under Imatinib therapy, a mortality rate of 6.6% and 10 patients in different phases of adjuvant therapy.
  
  
  CONCLUSIONS
  GIST has been imposed over the last decade as the main type of non-epithelial tumor of the digestive tract. The preoperative imagistic investigations can be very useful for setting the surgical strategy. The improvement of the mitotic index and/or Ki67 labeling index (LI) determination could render more accurate the scales for prognostic assessment. The two steps algorithm - surgery + adjuvant therapy - still remains the only option to make this dangerous condition a curable one.
authors.affiliation: Department of Intensive Care, University of Medicine and Pharmacy of Craiova and Department of Intensive Care, Emergency County Hospital of Craiova, Romania; luminita.chiutu@gmail.com.
authors.forename: Iancu Emil
authors.initials: IE
authors.lastname: Pleşea
authors.forename: Luminiţa
authors.initials: L
authors.lastname: Chiuţu
authors.forename: Silviu Iulian
authors.initials: SI
authors.lastname: Bordu
authors.forename: Ion
authors.initials: I
authors.lastname: Georgescu
authors.forename: Eugen Florin
authors.initials: EF
authors.lastname: Georgescu
authors.forename: Dana
authors.initials: D
authors.lastname: Ciobanu
authors.forename: Nicolae-Dragoş
authors.initials: ND
authors.lastname: Mărgăritescu
authors.forename: Violeta
authors.initials: V
authors.lastname: Comănescu
authors.forename: Răducu
authors.initials: R
authors.lastname: Nemeş
mesh_terms: D017677:Age Distribution; D000368:Aged; D002467:Cell Nucleus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019394:Ki-67 Antigen