https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/201 Sat, 22 Apr 2017 10:43:32 +0000 Abstract Background and objectives:Gastrointestinal stromal tumor (GISTs) is an uncommon and rare disease in Bangladesh. Our aims were to describe socio-demographic characteristics, clinical presentations, anatomical location, morphological variation, treatment and outcome of GIST in ten cases. Methods:This study included consecutive ten cases of GISTs diagnosed and treated in two tertiary level hospitals in Dhaka, Bangladesh from 2013 to 2016. Patients’ socio-demographic characteristics, clinical presentations, anatomical location, histological types, presence of CD117 markers were determined. Outcome of the treatment by surgical intervention and imatinib mesylate (400mg/day) were evalauted. Results: Total 10 patients were included in the study. Among them 6 were male and 4 were female. The age range was 32-74 years. Abdominal pain, haematemesis, melaena, haematochezia and anaemia were the most common presentation. One patient had dysphagia and another had features of subacute intestinal obstruction. Five patients had GIST in the stomach (50%), two had in colon and one in esophagus, duodenum and ileum respectively. CD 117 was positive in 8 cases, majority had spindly type cell with low mitotic figure. Imatinib therapy was given in all the cases except two patients. Disease recurrence in the form liver metastasis was found in two cases and both died. Disease free survival for more than 2 years was observed in 4 cases. Conclusion: Haematemesis and melaena were common presentation of GISTs. Stomach was the most common site for GISTs and majority had spindle type of cells and positive CD117 marker. Surgical intervention and imatinib therapy was found effective. IMC J Med Sci 2017; 11(2): 45-49. DOI: https://doi.org/10.3329/imcjms.v11i2.33094 Address for Correspondence: Dr. Md. Nazmul Hoque, Consultant and Head, Department of GHPD, Ibrahim Medical College & BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka, Bangladesh. Email: alifbd@gmail.com   Introduction Gastrointestinal stromal tumors (GISTs) are the mesenchymal tumors of the gastrointestinal tract (GI) and account for less than 1% of GI tumors [1]. About 60%-70% GIST arises from the stomach and the rest are from small intestine (20% to 30%), colon and rectum (5%), and esophagus (<5%) [2]. A small number of stromal tumors may originate from outside the gastrointestinal tract. These are designated as extragastrointestinal stromal tumors (EGISTs) [3]. Historically, these lesions were classified as leiomyomas or leiomyosarcomas because they possessed smooth muscle features. With the advent of immunohistochemical staining techniques GISTs now are recognized as a distinct group of mesenchymal tumors. GISTs express c-kit protein also known as CD117, and is considered a specific marker that differentiates GIST from other mesenchymal tumors such as leiomyomas [4]. The most common clinical manifestation for symptomatic GIST is pain in abdomen and GI bleeding from mucosal ulceration [5]. Other presentations include mass in the abdomen or intestinal obstruction. Endoscopy and colonoscopy clearly delineate the site and macroscopic appearance. However, ultrasonography (USG) and computerized tomographic (CT) scan are useful to determine the location of tumor in the gastric or intestinal wall [6]. Tumors less than 2 cm in diameter with a mitotic rate of <5/50 HPF (high power field) have been shown to have lower risk of recurrence than larger tumors. All GIST tumors should be considered to have malignant potential [7]. At present, surgery remains the mainstay of treatment for GIST. Recently, imatinib mesylate has been introduced as an adjunct therapy for metastatic disease, for non resectable tumor and for prevention of recurrence [5]. In this report, we describe the socio-demographic characteristics, clinical presentations, anatomical location, investigations, morphological variation, treatment and outcome of GIST encountered over four years period at two tertiary care hospitals.   All the patients diagnosed with GISTs from 2013 to 2016 at two tertiary care of hospitals (BIRDEM General Hospital and Gastroliver Hospital) of Dhaka city were included in the study.GIST cases were analyzed for age, sex, clinical features, tumor location, size, histological characteristics and CD117 marker. Types of surgery, post operative event, outcome of imatinib therapy, disease recurrence, recurrence site and survival rate were also analyzed. Mitotic figure defined as number of mitosis per 50 HPF (high power field). Disease recurrence means local recurrence or distant metastasis. GIST cases with inconclusive histological findings during the study period were excluded. Long term follow up at intervals were done by clinical examination, routine blood test and abdominal USG. 2026 Ibrahim Medical College. All rights reserved.