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Il Giornale di Chirurgia

GIST gastrico: aspetti clinici diversi della stessa malattia

Articolo, 96 - 99
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Abstract
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Introduction: GIST are mesenchymal tumours of the gastro-intestinal tract, that occurs frequently in the stomach. They are often asymptomatic, but may present as an acute or recurrent bleeding at first clinical presentation. CT scan and endoscopy may be helpful for diagnosis, while PET in more useful in the follow-up. Molecular analysis with the detection of the KIT (CD117) marker, may suggest the diagnosis in the 95% of cases. Surgery is the treatment of choice, but a multidisciplinary approach is very important to achieve a good result and to improve the prognosis of these tumours.
Case reports: We report three cases of gastric GIST that presented in different clinical ways: massive bleeding with liver matastasis, completely aymptomatic, and locally advanced gastric tumour with massive bleeding and consequent incomplete resection. All the three patients had total gastrectomy but only in one case we performed a radical surgery. Molecular therapy let us achieve a good control even in the advanced disease.
Discussion: The clinical, radiological and pathological features of these tumours and their impact on prognosis are discussed. The size and the proliferation index are the most important factors predictive for a good outcome.
Conclusions: Gastric GIST is a multiform tumour that may have different clinical presentations. A radical surgical approach followed by molecular therapy is the gold standard.

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