[Gastrointestinal stromal tumors localized in small intestine and diagnosed preoperatively as gynecological neoplasms]

Abstract

Objectives: The aim of the study was the analysis of women with gastrointestinal stromal tumors (GIST) of small intestine treated and followed-up in Cancer Center-Institute in Warsaw, who were primary operated in gynecological departments due to suspicion of gynecological neoplasm.

Materials and methods: In the database of Clinical GIST Registry from 2001 to 2004 we identified 44 women with the diagnosis of CD117(+) GIST of small intestine, what corresponds to 34% (44/130) all female GIST patients. Sixteen of them (36.4%, 16/44) were primary operated on in gynecological departments due to the tentative diagnosis of gynecological neoplasm.

Results: The only indication for operation in 29 women was undiagnosed microscopically tumor of the pelvis. Sixteen of them (55.2%, 16/29) were operated on schedule in gynecological departments. The others 15 patients were operated due to: ileus and perforation of digestive tract (8), gastrointestinal bleeding (3), abdominal pain (2) and others (2). In analyzed group of patients 20 women (45.5%) after GIST excision remain without evidence of disease with median follow-up time of 9 months, and in 24 patients (54.5%) GIST recurred in median time of 18.5 months. In this latter group 23 patients were treated with imatinib due to inoperable/metastatic lesions. Estimated 2-year overall survival (calculated form the date of imatinib introduction) was 75%.

Conclusions: GISTs, especially of small intestine, may simulate in women gynecological tumor, particularly of the ovary. Radical surgery remains the most effective method of GIST treatment. In inoperable/metastatic lesion the treatment of choice is tyrosinase kinase inhibitor--imatinib.