Download Free Medical Gastrointestinal Stromal Tumors PowerPoint Presentation

Gastrointestinal Stromal Tumors PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Familial GIST, which is titled "Gastrointestinal Stromal Tumors", to know about the GIST, the most common MESENCHYMAL tumor of GIT. Gastrointestinal Stromal Tumors (GIST) are Tumors that arise from the PLEURIPOTENT MESENCHYMAL CELLS in the intestinal tract that differentiate to neural, ganglionic or mixed mass.

Tags : Familial GIST, Gastrointestinal Stromal Tumors, common MESENCHYMAL, tumor of GIT, PLEURIPOTENT MESENCHYMAL CELLS, intestinal tract, neural, ganglionic, mixed mass

Published on : May 18, 2021 | Views : 2907 | Downloads : 8

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

GASTROINTESTINAL STROMAL TUMORS Dr ananth prabhu Razvi Rasid
Slide 2-

HISTORY Until late 1960s –SMOOTH MUSCLE NEOPLASM OF GI. In 1980-IMMUNOHISTOCHEMISTRY lacked features of smooth muscle differentiation. MAZUR and CLARK - GIST
Slide 3-

WHAT IS GIST ? Most common MESENCHYMAL tumor of GIT. Definition- Tumors that arise from the PLEURIPOTENT MESENCHYMAL CELLS in the intestinal tract that differentiate to neural, ganglionic or mixed mass.
Slide 4-

WHAT IS GIST ? Can be BENIGN or MALIGNANT. Recent research- tumor start in cells found in the wall of GI tract called INTERSTITIAL CELLS OF CAJAL (ICC). Or from a very early (primitive) cell in GI which ICC.
Slide 5-

ICC Ramon Y Cajal Modified smooth muscle cells with incomplete neurogenic and myogenic differentiation Between PNS and GI smooth muscle cell Muscularis propria Pacemaker activity
Slide 6-

ICC IN ACTION
Slide 7-

INCIDENCE Most common benign tumor M:F is 1:1 Peak at 5 th to 7 th decade
Slide 8-

DISTRIBUTION Stomach - 50-60% Small intestine - 20-30% Large intestine - 10% Esophagus - 5% Else where in abdomen - 5%
Slide 9-

RISK FACTORS Presence of NEUROFIBROMATOSIS Familial urticaria pigmentosa Familial GIST Carney’s triad -GIST, extra-adrenal paraganglioma and pulmonary chondroma
Slide 10-

Familial GIST I II III IV II I I II I III IV V III VI II VII VIII III IV
Slide 11-

CLASSIFICATION Differentiation towards smooth muscle cells- SMOOTH MUSCLE TYPE Differentiation towards neural elements- NEURAL TYPE(GANT) Dual differentiation- SMOOTH MUSCLE-NEURAL TYPE Lacking differentiation of either cell type- UNCOMMITTED
Slide 12-

GROSS APPEARANCE Single or Multiple Size- 1 cm to more than 20 cm Lobulated / multilobulated and well circumscribed (lack true capsule)
Slide 13-

GROSS…. Submucosal , Intramuscular or Subserosal mass Originates from muscular layer
Slide 14-

GROSS…. Prone to surface ulcerations and bleeding Shows areas of cystic degeneration,infarction ,h’ge and necrosis
Slide 15-

GROSS…. Cut surface gray to pink in color
Slide 16-

GROSS….
Slide 17-

MICROSCOPIC APPEARANCE 2 main cell types – SPINDLE TYPE EPITHELIOID TYPE
Slide 18-

SPINDLE TYPE
Slide 19-

SPINDLE TYPE Short,uniform,blunt ended,eosinophilic cytoplasm. Paranuclear vacuoles. Arranged in sheets,fascicles whorled,storiform or palisaded pattern. Gastric GISTs( corpus) and some SI and LI GISTs
Slide 20-

SPINDLE TYPE
Slide 21-

EPITHELIOID TYPE
Slide 22-

EPITHELIOID TYPE Abundant cytoplasm,round nuclei. Cytoplasmic vacuoles. Arranged in sheets or nest Variants- Clear cell, Signet ring, Oncocytic and Plasmacytoid Previously – Leiomyoblastoma. Gastric antrum
Slide 23-

EPITHELIOID TYPE
Slide 24-

GANT Epithelioid cell coponent more prominent Lymphocytic infiltration in stroma Greater MALIGNANT potential and risk of METASTASIS
Slide 25-

BENIGN vs MALIGNANT
Slide 26-

BENIGN vs MALIGNANT Features favoring benign lesion Size less than 5 cm Low number of mitosis / HPF NO mucosal invasion Low cellularity Low markers of cell proliferation WITH PROLONGED FOLLOW UP ANY GIST HAS MALIGNANT POTENTIAL
Slide 27-

PATHOPHYSIOLOGY c-KIT(85%) and PDGFRA(35%) mutation c-KIT – receptor for stem cell factor PDGFRA – receptor for PDGF Both have cytoplasmic TYROSINE KINASE that activates similar intracellular pathway KIT identified by looking for CD 117 antigen
Slide 28-

PATHOPHYSIOLOGY MUTATION Activation of TYROSINE KINASE pathway PROMOTING CELL PROLIFERATION and INHIBITION OF APOPTOSIS
Slide 29-

MUTATION Human pathology, Vol 33, May 2002
Slide 30-

CLINICAL FEATURE Depends upon – Tumor size and Location Many ASYMPTOMATIC – discovered incidentally during laparotomy or autopsy. Small lesion - INCIDENTALOMAS
Slide 31-

SIGNS AND SYMPTOMS ABDOMINAL PAIN BLEEDING OBSTRUCTION DYSPHAGIA ALTERED BOWEL HABITS PALPABLE ABDOMINAL MASS ENLARGED LIVER
Slide 32-

STAGING Stage 1 - Localised or locally advanced disease Stage 2 - Patients who present with perforated tumor at diagnosis Stage 3 – Patients with multiple primary lesion or distant metastases at diagnosis.
Slide 33-

GRADING
Slide 34-

INVESTIGATIONS RADIOLOGICAL ENDOSCOPY IMMUNOHISTOCHEMISTRY
Slide 35-

BARIUM X - RAY Used in past Barium swallow Barium enema RADIOLOGICAL
Slide 36-

RADIOLOGICAL… ENDOSCOPIC US Used to identify the precise location of the tumor and to determine size Also extend of spread
Slide 37-

RADIOLOGICAL… COMPUTED TOMOGRAPHY Location and size Speard into abdomen or liver.
Slide 38-

RADIOLOGICAL… MRI Useful in looking for RECURRENCE or METASTASES.
Slide 39-

RADIOLOGICAL… PET Most useful for spotting GIST Radioactive GLUCOSE given I.V Used to see if drug therapy is working
Slide 40-

ppt slide no 40 content not found
Slide 41-

ENDOSCOPY
Slide 42-

ENDOSCOPY…
Slide 43-

IMMUNOHISTOCHEMISTRY To confirm the tumor after getting tissue sample. Antibodies attach to KIT protein (CD 117) Color changes on cell surface if KIT present Specific for GIST
Slide 44-

DIFFERENTIAL DIAGNOSIS GASTRIC CARCINOMA LYMPHOMA LEIOMYOSARCOMA
Slide 45-

SURGICAL AIMS – Remove all gross tumor Wide margin not generally necessary Systemic lymphadenectomy unnecessary LAPAROTOMY LAPAROSCOPY
Slide 46-

SURGICAL… COMPLETE SURGICAL RESECTION WITHOUT RUPTURE Smaller lesion (<4 cm) – WEDGE RESECTION Large lesion can’t be distinguished from malignant counterpart- GASTRECTOMY with minimal proximal margin of 4 cm
Slide 47-

ppt slide no 47 content not found
Slide 48-

LAPAROSCOPIC SURGERY INDICATIONS Small (3 cm) Localised Typically characterised as being BENIGN or LOW GRADE MALIGNANT COMPLICATIONS Perforation Tumor rupture
Slide 49-

LAPAROSCOPIC SURGERY
Slide 50-

MEDICAL TARGETED THERAPY COMBINED THERAPY TARGETED THERAPY Imatinib mesylate Selective tyrosine kinase inhibitor Given orally Dose- 400-600mg/day
Slide 51-

ATP = imanitib contact point Proliferation Survival Adhesion Invasion Metastasis Angiogenesis Imatinib MEDICAL…
Slide 52-

INDICATIONS FOR IMATINIB High risk tumor Tumor rupture Multifocal tumor Positive margin Metastasis
Slide 53-

EFFECT OF IMATINIB ON GIST
Slide 54-

RESISTANCE TO IMATINIB
Slide 55-

MEDICAL… COMBINED THERAPY GIST –vascular tumor so VEGF Bevacizumab + imatinib RAD 001 +imatinib PKC412 + imatinib
Slide 56-

RECURRENT OR METASTATIC GIST Before IMATINIB era = POOR Median survival- 6 – 18 mth Cause- TUMOR RUPTURE Site – PERITONEUM and LIVER Treatment -SURGICAL RESECTION -IMATINIB -CHEMOEMBOLIZATION OF LIVER METS
Slide 57-

HEPATIC ARTERY EMBOLISATION
Slide 58-

FOLLOW UP EVERY 3 MONTHS FOR 2 YEARS THEN EVERY 6 MONTHS FOR 3 YEARS
Slide 59-

SUMMARY GIST is now well characterized. All have malignant potential. Complete surgical resection important. Metastatic disease respond to IMATINIB.
Slide 60-

ppt slide no 60 content not found
Slide 61-

ppt slide no 61 content not found
Slide 62-

ppt slide no 62 content not found
Slide 63-

ppt slide no 63 content not found
Slide 64-

ppt slide no 64 content not found
Slide 65-

THANK YOU