Two cases of malignant gastric GIST - gastrointestinal stromal tumor
In this paper we present two patients who underwent surgery due to gastric GIST with histological signs of malignancy. The first patient was a 73 year old male with a 35x18x7 cm primary tumor. The tumor was successfully removed and the patient was followed for 4 month when he stopped reporting to scheduled followup visits. The second patient, a 45 year old male, underwent surgery for malignant GIST in another institution. This patient was admitted to our Clinic because of tumor recurrence of 19x13x7 cm in the upper left abdominal quadrant. Surgery was performed successfully but afterwards the patient didn't report to scheduled control visits. Pathohistologic analysis revealed in both cases a rather well delimited tumor with corresponding necrosis and hemorrhage zones, built from clusters of solid spindle-shaped and oval cels showing high mitotic activity (up to 5 mitoses in 10 HPF in the first patient and up to 28 mitoses in 50 HPF in the second). The tumors infiltrated the serosa and muscular layer of the gastric wall but the mucous membrane was not affected and there were no signs of metastasis in the regional lymph nodes. Proliferation activity, measured by Ki-67, was present focally in 10% of tumor cells in the first patient and in 8% in the second. Immunohistochemical analysis (CD 34, CD 117) was positive and demonstrated malignant characteristics of GIST in both cases. An adequate follow of these patients in the post-operative period as well as application of adjuvant therapy at our hospital was not possible because they probably continued the treatment in other institutions. This is dificult to verify as there is no uniform register of these patients in spite of the fact that these tumors are relatively rare.
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