Pediatric gastrointestinal stromal tumors and leiomyosarcoma

The St. Jude Children's Research Hospital experience and a review of the literature

Authors

  • Monica S. Cypriano M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Jesse J. Jenkins M.D.,

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pathology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Alberto S. Pappo M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    Current affiliation:
    1. Division of Hematology-Oncology, University of Toronto/The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Bhaskar N. Rao M.D.,

    1. Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Najat C. Daw M.D.

    Corresponding author
    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    • Department of Hematology-Oncology, Mail Stop 260, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794
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    • Fax: (901) 521-9005


Abstract

BACKGROUND

With the introduction of molecularly targeted therapy for gastrointestinal stromal tumors (GISTs), it became important to distinguish GISTs from leiomyosarcomas (LMSs). The authors sought to characterize the clinicopathologic features of these tumors in pediatric patients.

METHODS

The authors reviewed the medical records of 11 patients for whom GIST or LMS was diagnosed between March 1962 and July 2002 at St. Jude Children's Research Hospital and reclassified the tumors according to current histologic and immunophenotypic criteria. The authors also reviewed the literature pertaining to pediatric GISTs and LMSs.

RESULTS

Seven patients had GISTs, and four had LMS. The median age of the patients at diagnosis was 11.5 years. At diagnosis, metastases were present in one patient with GISTs and in another with LMS. Unlike the focal distribution of CD117 (KIT) in LMS, diffuse and strong immunostaining was observed in GISTs. Only GISTs expressed CD34. Six patients underwent complete resection (four with GISTs and two with LMS), four patients underwent incomplete resection (three with GISTs and one with LMS), and one patient (with LMS) underwent a biopsy only. Radiotherapy or chemotherapy was used to treat one patient with GISTs and three patients with LMS. One patient with a high-risk GIST (largest dimension of 32 cm and high mitotic count) was treated with adjuvant imatinib mesylate outside the preferred setting of a clinical trial, due to concerns regarding the high risk of tumor recurrence. Four patients with GISTs and two with LMS survived median disease-free a median of 10.4 years and 4.3 years after diagnosis, respectively. Tumors in all but one survivor were completely resected.

CONCLUSIONS

KIT staining helped to distinguish GISTs from LMSs. Surgery was the treatment of choice for both entities, and tumor resectability was a key prognostic factor. Cancer 2004. © 2004 American Cancer Society.

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