Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(02): 133-140
DOI: 10.4103/ijri.IJRI_354_18
Gastro-Intestinal Imaging

Gastrointestinal Stromal Tumor (GIST) from esophagus to anorectum – diagnosis, response evaluation and surveillance on computed tomography (CT) scan

Sushil N Panbude
Departments of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Suman K Ankathi
Departments of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Anant T Ramaswamy
Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Avanish P Saklani
Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
Subject Editor: Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Abstract

Gastrointestinal stromal tumor (GIST) are the most common non epithelial tumor of the gastrointestinal (GI) tract. They arise from interstitial cells of Cajal present in the myenteric plexus. They can also arise outside the GI tract from mesentery, retro peritoneum and omentum. With the advent of new targeted molecular therapy c- tyrosine kinase inhibitor (Imatinib), it has become important to differentiate between response and pseudo-progression of the disease as response evaluation criteria for GIST are different from Response Evaluation Criteria in Solid Tumors (RECIST). Purpose of this pictorial essay is to enumerate the characteristic CT features of GIST, and discuss atypical features and response evaluation criteria.

Keywords

GIST - gastrointestinal - tumor - imatinib


Publication History

Article published online:
22 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Lakshmi VA, Chacko RT, Kurian S. Gastrointestinal stromal tumors: A 7-year experience from a tertiary care hospital. Indian J Pathol Microbiol 2010; 53: 628-33
    CrossrefPubMedGoogle Scholar
  • 2 Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol 2002; 3: 655-64
    CrossrefPubMedGoogle Scholar
  • 3 Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumour. Lancet 200719 369: 1731-41
    CrossrefPubMedGoogle Scholar
  • 4 Steigen SE, Eide TJ. Gastrointestinal stromal tumors (GISTs): A review. APMIS 200912 117: 73-86
    CrossrefPubMedGoogle Scholar
  • 5 Nishida T, Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol 2000; 15: 1293-301
    PubMedGoogle Scholar
  • 6 DeMatteo RP. The GIST of targeted cancer therapy: A tumor (gastrointestinal stromal tumor), a mutated gene (c-kit), and a molecular inhibitor (STI571). Ann Surg Oncol 2002; 9: 831-9
    CrossrefPubMedGoogle Scholar
  • 7 Marrari A, Wagner AJ, Hornick JL. Predictors of response to targeted therapies for gastrointestinal stromal tumors. Arch Pathol Lab Med 2012; 136: 483-9
    CrossrefPubMedGoogle Scholar
  • 8 Poveda A, García Del Muro X, Antonio López-Guerrero J, Cubedo R, Martínez V, Romero I. et al. Tumour review GEIS guidelines for gastrointestinal sarcomas (GIST). Cancer Treat Rev 2017; 55: 107-19
    CrossrefPubMedGoogle Scholar
  • 9 Tirumani SH, Jagannathan JP, Krajewski KM, Shinagare AB, Jacene H, Ramaiya NH. Imatinib and beyond in gastrointestinal stromal tumors: A radiologist’s perspective. Am J Roentgenol 2013; 201: 801-10
    CrossrefPubMedGoogle Scholar
  • 10 Tirumani SH, Baheti AD, Tirumani H, O’Neill A, Jagannathan JP. Update on Gastrointestinal stromal tumors for radiologists. Korean J Radiol 2017; 18: 84-93
    CrossrefPubMedGoogle Scholar
  • 11 O’Regan KN, Shinagare AB, Saboo SS, Ramaiya NH, Jagannathan JP, Tirumani SH. Gastrointestinal stromal tumors (GIST): Lesser known facts. Clin Imaging 2013; 37: 821-9
    CrossrefPubMedGoogle Scholar
  • 12 Tirumani SH, Tirumani H, Jagannathan JP, Shinagare AB, Hornick JL, George S. et al. MDCT features of succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumours. Br J Radiol 2014; 87: 20140476
    CrossrefPubMedGoogle Scholar
  • 13 Joensuu H, Roberts PJ, Sarlomo-Rikala M, Andersson LC, Tervahartiala P, Tuveson D. et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 2001; 344: 1052-6
    CrossrefPubMedGoogle Scholar
  • 14 Heinrich MC, Rankin C, Blanke CD, Demetri GD, Borden EC, Ryan CW. et al. Correlation of long-term results of imatinib in advanced gastrointestinal stromal tumors with next-generation sequencing results. JAMA Oncol 2017; 3: 944
    CrossrefPubMedGoogle Scholar
  • 15 Bamboat ZM, Dematteo RP. Updates on the management of gastrointestinal stromal tumors. Surg Oncol Clin N Am 2012; 21: 301-16
    CrossrefPubMedGoogle Scholar
  • 16 Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG. et al. NCCN task force report: Update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010(Suppl 2):S1-41; quiz S42-4
  • 17 Akahoshi K, Sumida Y, Matsui N, Oya M, Akinaga R, Kubokawa M. et al. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007; 13: 2077-82
    CrossrefPubMedGoogle Scholar
  • 18 Serrano C, George S. Recent advances in the treatment of gastrointestinal stromal tumors. Ther Adv Med Oncol 2014; 6: 115-27
    CrossrefPubMedGoogle Scholar
  • 19 Montemurro M, Gelderblom H, Bitz U, Schütte J, Blay JY, Joensuu H. et al. Sorafenib as third- or fourth-line treatment of advanced gastrointestinal stromal tumour and pretreatment including both imatinib and sunitinib, and nilotinib: A retrospective analysis. Eur J Cancer 2013; 49: 1027-31
    CrossrefPubMedGoogle Scholar
  • 20 Demetri GD, Reichardt P, Kang Y-K, Blay J-Y, Rutkowski P, Gelderblom H. et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): An international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381: 295-302
    CrossrefPubMedGoogle Scholar
  • 21 Tirkes T, Hollar MA, Tann M, Kohli MD, Akisik F, Sandrasegaran K. Response criteria in oncologic imaging: Review of traditional and new criteria. RadioGraphics 2013; 33: 1323-41
    CrossrefPubMedGoogle Scholar
  • 22 Choi H, Charnsangavej C, Faria S de C, Tamm EP, Benjamin RS, Johnson MM. et al. CT Evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: A quantitative analysis correlated with FDG PET findings. Am J Roentgenol 2004; 183: 1619-28
    CrossrefPubMedGoogle Scholar
  • 23 Vernuccio F, Taibbi A, Picone D, LA Grutta L, Midiri M, Lagalla R. et al. Imaging of gastrointestinal stromal tumors: From diagnosis to evaluation of therapeutic response. Anticancer Res 2016; 36: 2639-48
    Google Scholar
  • 24 Chan KP. What’s the Mass? The gist of point-of-care ultrasound in gastrointestinal stromal tumors. Clin Pract Cases Emerg Med 2018; 2: 82-5
    CrossrefPubMedGoogle Scholar
  • 25 Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: Radiologic features with pathologic correlation1. RadioGraphics 2003; 23: 283-304
    CrossrefPubMedGoogle Scholar
  • 26 Takizawa I, Morishita H, Matsuki S, Komeyama T, Emura I, Hara N. Primary gastrointestinal stromal tumor in the retroperitoneum. Int J Urol 2006; 13: 1245-8
    CrossrefPubMedGoogle Scholar
  • 27 Casella C, Villanacci V, D’Adda F, Codazzi M, Salerni B. Primary extra-gastrointestinal stromal tumor of retroperitoneum. Clin Med Insights Oncol 2012; 6: 189
    CrossrefPubMedGoogle Scholar
  • 28 Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: A clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol 2000; 24: 211-22
    CrossrefPubMedGoogle Scholar
  • 29 Shinagare AB, Zukotynski KA, Krajewski KM, Jagannathan JP, Butrynski J, Hornicke JL. et al. Esophageal gastrointestinal stromal tumor: Report of 7 patients. Cancer Imaging 2012; 12: 100-8
    CrossrefPubMedGoogle Scholar
  • 30 Gong J, Kang W, Zhu J, Xu J. CT and MR imaging of gastrointestinal stromal tumor of stomach: A pictorial review. Quant Imaging Med Surg 2012; 2: 274-9
    PubMedGoogle Scholar
  • 31 Buckley J, Fishman EK. CT evaluation of small bowel neoplasms: Spectrum of disease1. Radiographics 1998; 18: 379-92
    CrossrefPubMedGoogle Scholar
  • 32 Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Anorectal gastrointestinal stromal tumors: CT and MR imaging features with clinical and pathologic correlation. Am J Roentgenol 2003; 180: 1607-12
    CrossrefPubMedGoogle Scholar
  • 33 Yamamoto H, Oda Y, Kawaguchi K, Nakamura N, Takahira T, Tamiya S. et al. c-kit and PDGFRA mutations in extragastrointestinal stromal tumor (gastrointestinal stromal tumor of the soft tissue). Am J Surg Pathol 2004; 28: 479-88
    CrossrefPubMedGoogle Scholar
  • 34 Goh BK, Chow PK, Kesavan SM, Yap WM, Chung YF, Wong WK. A single-institution experience with eight CD117-positive primary extragastrointestinal stromal tumors: Critical appraisal and a comparison with their gastrointestinal counterparts. J Gastrointest Surg 2009; 13: 1094-8
    CrossrefPubMedGoogle Scholar
  • 35 Agaimy A, Wünsch PH. Gastrointestinal stromal tumours: A regular origin in the muscularis propria, but an extremely diverse gross presentation. Langenbeck’s Arch Surg 2006; 391: 322-9
    CrossrefPubMedGoogle Scholar
  • 36 Li Z, Huan X, Liang X, Li Z, Tan A. Clinicopathological and immunohistochemical study of extra-gastrointestinal stromal tumors arising from the omentum and mesentery. Chinese J Pathol 2005; 34: 11-4
    Google Scholar
  • 37 Hong X, Choi H, Loyer EM, Benjamin RS, Trent JC, Charnsangavej C. Gastrointestinal stromal tumor: Role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. RadioGraphics 2006; 26: 481-95
    CrossrefPubMedGoogle Scholar
  • 38 Patnaik S, Jyotsnarani Y, Rammurti S. Radiological features of metastatic gastrointestinal stromal tumors. J Clin Imaging Sci 2012; 2: 43
    CrossrefPubMedGoogle Scholar
  • 39 Sripathi S, Rajagopal K, Srivastava RK, Ayachit A. CT features, mimics and atypical presentations of gastrointestinal stromal tumor (GIST). Indian J Radiol Imaging 2011; 21: 176-81
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Tirumani SH, Shinagare AB, Jagannathan JP, Krajewski KM, Ramaiya NH, Raut CP. Radiologic assessment of earliest, best, and plateau response of gastrointestinal stromal tumors to neoadjuvant imatinib prior to successful surgical resection. Eur J Surg Oncol 2014; 40: 420-8
    CrossrefPubMedGoogle Scholar
  • 41 Joensuu H, Eriksson M, Sundby Hall K, Hartmann JT, Pink D, Schütte J. et al. One vs Three years of adjuvant imatinib for operable gastrointestinal stromal tumor. JAMA 2012; 307: 1265
    CrossrefPubMedGoogle Scholar
  • 42 Demetri GD, von Mehren M, Blanke CD, Van den Abbeele AD, Eisenberg B, Roberts PJ. et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002; 347: 472-80
    CrossrefPubMedGoogle Scholar
  • 43 Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR. et al. Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: Proposal of new computed tomography response criteria. J Clin Oncol 2007; 25: 1753-9
    CrossrefPubMedGoogle Scholar
  • 44 Demetri GD, van Oosterom AT, Garrett CR, Blackstein ME, Shah MH, Verweij J. et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: A randomised controlled trial. Lancet 2006; 368: 1329-38
    CrossrefPubMedGoogle Scholar
  • 45 Schramm N, Englhart E, Schlemmer M, Hittinger M, Übleis C, Becker CR. et al. Tumor response and clinical outcome in metastatic gastrointestinal stromal tumors under sunitinib therapy: Comparison of RECIST, Choi and volumetric criteria. Eur J Radiol 2013; 82: 951-8
    CrossrefPubMedGoogle Scholar
  • 46 Shinagare AB, Barysauskas CM, Braschi-Amirfarzan M, O’Neill AC, Catalano PJ, George S. et al. Comparison of performance of various tumor response criteria in assessment of sunitinib activity in advanced gastrointestinal stromal tumors. Clin Imaging 2016; 40: 880-4
    CrossrefPubMedGoogle Scholar
  • 47 Shinagare AB, Jagannathan JP, Kurra V, Urban T, Manola J, Choy E. et al. Comparison of performance of various tumour response criteria in assessment of regorafenib activity in advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib. Eur J Cancer 2014; 50: 981-6
    CrossrefPubMedGoogle Scholar
  • 48 Shankar S, vanSonnenberg E, Desai J, DiPiro PJ, Van Den Abbeele A, Demetri GD. Gastrointestinal stromal tumor: New nodule-within-a-mass pattern of recurrence after partial response to imatinib mesylate. Radiology 2005; 235: 892-8
    CrossrefPubMedGoogle Scholar