R. Cuberes et al., Stromal tumors of the stomach. Review of our experience and reclassification of a series of patients, REV ESP E D, 92(1), 2000, pp. 20-26
OBJECTIVE: to retrospectively review a series of 12 patients operated on in
our department for stromal tumor of the stomach. Clinical and morphologica
l data, and the patients' postoperative course, were analyzed.
METHODS: medical records for 12 patients (mean age 63.3 years) were retrosp
ectively reviewed to obtain data on clinical presentation, diagnosis and tr
eatment. Surgical morbidity and mortality were analyzed. A pathologist revi
ewed the resected specimens to determine the morphological factors of progn
ostic value. The biological nature of the tumor was reclassified based excl
usively on mitotic index, and all tumors were staged according to the TGM s
ystem. Recurrence and survival rates were also calculated.
RESULTS: the most frequent clinical presentation was abdominal pain and gas
trointestinal bleeding. The most sensitive diagnostic methods were computer
ized tomography and echographic endoscopy. Operability and resectability ra
tes were 100% and 91.6% respectively. Local resection was done in 5 patient
s, partial gastrectomy in 5, and extended total gastrectomy in 1. Histologi
cally, 6 cases were muscular tumors (2 leiomyomas, 3 low-grade leiomyosarco
mas and 1 high-grade leiomyosarcoma), 2 were gas trointestinal autonomic ne
rve (GAN) tumors, and 4 were pure stomal tumors. The morbidity rate was 33.
3% and the mortality rate was 8.3% (1 patient). All patients were followed
up: 1 patient each died after 9 months and 4 years, 1 developed liver metas
tases after a disease-free interval of 14 months, and the other 9 patients
were still alive and free of disease after intervals ranging from 4 months
to 7 years.
CONCLUSIONS: stromal tumors include a group of tumors which may present mus
cular differentiation (the most frequent type), neural differentiation (GAN
tumors) or no differentiation at all (pure stromal tumors). The mitotic in
dex is the most valid parameter to determine biological nature, considering
that classification as a benign tumor requires the total absence of mitose
s. Treatment was mostly surgical, and local resection with adequate safety
margins was effective. Prognosis was relatively good, but long-term followu
p is needed to assess the malignant potential of these tumors.