title: Gastrointestinal stromal tumors with exon 8 c-kit gene mutation might occur at extragastric sites and have metastasis-prone nature.
abstract: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the human gut. Most sporadic GISTs have somatic gain-of-function mutations of the c-kit gene. The mutations are frequently found at exon 11, sometimes at exon 9 and rarely at exon 13 or 17. Recently, exon 8 c-kit gene mutations were reported in very minor proportion of sporadic GISTs. We also found 3 GISTs with exon 8 c-kit gene mutations in approximately 1,000 sporadic GISTs examined. In the present report, we showed the clinicopathological data of those GISTs. One case had a deletion of codon 419 of aspartate, and 2 cases had a substitution of 3 amino acids of codon 417 to codon 419 to tyrosine. The former was the same mutation recently reported in 2 GIST cases, but the latter has not been reported in any GISTs. All three cases occurred at extragastric sites and two of three showed distant metastasis. Since the remaining case was regarded as high risk for recurrence, imatinib adjuvant treatment has been done without evidence of metastasis. Our results confirmed the idea that exon 8 mutations are minor but actually existing abnormalities in sporadic GISTs, and suggested that such GISTs have a feature of extragastric development and a metastasis-prone nature. Since the exon 8 mutations appeared to be really sensitive to imatinib as shown in the present case study, accurate genotyping including exon 8 of the c-kit gene is necessary in GISTs to predict response to imatinib in both the unresectable/metastatic and adjuvant settings.
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine Hyogo, Japan ; Department of Pathology, Sanda Municipal Hospital Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Clinical Oncology, Kawasaki Medical School Okayama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamura
authors.affiliation: Department of Surgery, Division of Gastroenterology, Kawasaki Medical School Okayama, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences Niigata, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Surgery, Sanjo General Hospital Niigata, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.affiliation: Department of Surgery, Faculty of Medicine, Kinki University Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakai
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine Hyogo, Japan.
authors.forename: Mizuka
authors.initials: M
authors.lastname: Ohkouchi
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine Hyogo, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Hashikura
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine Hyogo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Isozaki
authors.affiliation: Department of Surgical Pathology, Hyogo College of Medicine Hyogo, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hirota
mesh_terms: D000328:Adult; D005091:Exons; D005770:Gastrointestinal Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D046152:Gastrointestinal Stromal Tumors / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis / Q000235:genetics* / Q000473:pathology; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*
chemical_list: D019009:Proto-Oncogene Proteins c-kit
keywords: GIST; c-kit gene; exon 8; gain-of-function mutation; imatinib; sunitinib