| Abstract | Cilj istraživanja: Osnovni ciljevi ovog istraživanja bili su istražiti incidenciju gastrointestinalnih stromalnih tumora (GIST) dijagnosticiranih u KBC Split u razdoblju od 2021. godine do 2023. godine, te evaluirati sve dostupne kliničko-patološke parametre.
Ispitanici i postupci: U istraživanje je uključeno 50 pacijenta kojima je u razdoblju od 1. siječnja 2021. godine do 31. prosinca 2023. godine u Zavodu za patologiju, citologiju i sudsku medicinu KBC-a Split postavljena dijagnoza GIST-a. Uvidom u medicinsku dokumentaciju dobiveni su ostali kliničko-patološki podaci (dob, spol, vrsta uzorka, lokalizacija, veličina tumora, histološki tip, histološki gradus, mitotski indeks, primjenjena imunohistokemijska bojenja, Ki-67 proliferacijski indeks, prognostička grupa, rizik povrata bolesti, TNM stadij). Za usporedbu ispitivanih varijabli korišten je χ2-test.
Rezultati: Od ukupno 50 pacijenata sa dijagnozom GIST-a bilo je 25 muškaraca (50%) i 25 žena (50%) (P = 1,000). Medijan životne dobi iznosio je 68 godina (raspon 44-89 godina). Želudac je bio statistički značajno najčešće primarno sijelo GIST-a (P < 0,001), a vretenasti podtip najčešći histološki podtip (P < 0,001). Medijan veličine tumora bio je 5 cm (raspon 0,7-21 cm), a 36 (92%) tumora je pri inicijalnoj dijagnozi bilo unifokalno (P < 0,001). Medijan mitotskog indeksa iznosio je 3 (raspon 0-95), a 32 (80%) tumora imalo je ≤ 5 mitoza/mm² (P < 0,001). Imunohistokemijskim bojenjem 100% tumora bilo je CD117 pozitivno, 97% DOG-1 pozitivno, a 76% CD34 pozitivno. Zabilježena je statistički značajna razlika u raspodjeli tumora u prognostičke grupe prema AFIP klasifikaciji, pri čemu je najveći broj tumora bio u grupi 2 (P = 0,003). U 10 (24%) pacijenata zabilježeno je sinhrono postojanje drugog tumora (P = 0,034). Usporedbom biotičkih i resekcijskih uzorka, kao i usporedbom primarnog tumora sa recidivom i metastazom, zabilježena je visoka razina podudarnosti dostupnih imunohistokemijskih bojenja.
Zaključci: Gastrointestinalni stromalni tumori javljaju se u pacijenta više životne dobi, podjednako u muškaraca i žena, s najčešćim sijelom u području želudca. Imunohistokemijska ekspresija CD117 i DOG-1 protutijela visoko je specifična i pouzdana metoda u dijagnostici GIST-a, a kombinacija ovih markera korisna je za dijagnozu primarnog tumora, te potvrdu lokalnih recidiva i metastaza. |
| Abstract (english) | Objectives: The primary objectives of this study were to investigate the incidence of gastrointestinal stromal tumors (GIST) diagnosed at the University Hospital Center Split from 2021 to 2023 and to evaluate all available clinical and pathological parameters.
Subjects and procedures: The study included 50 patients who were diagnosed with GIST at the Department of Pathology, Cytology, and Forensic Medicine of the University Hospital Center Split from January 2021 to December 2023. Clinical and pathological data were obtained from medical records, including age, sex, type of sample, tumor localization, size, histological type, histological grade, mitotic index, applied immunohistochemical stainings, Ki-67 proliferation index, prognostic group, risk of recurrence, and TNM stage. The χ2-test was used to compare the examined variables.
Results: Out of a total of 50 patients diagnosed with GIST, there were 25 men (50%) and 25 women (50%) (P = 1.000). The median age was 68 years (range 44-89 years). The stomach was statistically the most common primary site of GIST (P < 0.001), and the spindle cell subtype was the most common histological subtype (P < 0.001). The median tumor size was 5 cm (range 0.7-21 cm), and 36 (92%) tumors were unifocal at initial diagnosis (P<0.0001). The median mitotic index was 3 (range 0-95), and 32 (80%) tumors had ≤ 5 mitoses/mm² (P < 0.001). Immunohistochemical staining results showed that 100% of tumors were CD117 positive, 97% were DOG-1 positive, and 76% were CD34 positive. There was a statistically significant difference in the distribution of tumors in prognostic groups according to the AFIP classification, with the largest number of tumors classified as group 2 (P = 0.003). Synchronous occurrence of another tumor was noted in 10 (24%) patients (P = 0.034). A high level of concordance among the available immunohistochemical stainings was observed by comparing biopsy and resection samples, as well as by comparing the primary tumor with recurrences and metastases.
Conclusions: GISTs occur in older age patients, equally in men and women, with the stomach as the most common site. Immunohistochemical expression of CD117 and DOG-1 antibodies is a highly specific and reliable method in determing the GIST. The combination of these markers is useful for diagnosis of the primary tumor, as well as confirming local recurrences and metastases. |
