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Video Endoscopic Sequence 1 of 4.
Gastrointestinal Stromal Tumor (GIST)
This is a 55-year-old female, that is hospitalized due to a bleeding from the upper digestive tract.
At endoscopy, this sub-mucous mass is found with a giant ulcer with visible blood vessels. The endoscopic image is from a GIST that was confirmed by biopsies.
For more endoscopic details download the video clips by clicking on the endoscopic images, wait to be downloaded complete then press Alt and Enter; thus you can observe the video in full screen.
All endoscopic images shown in this Atlas contain
video clips
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Video Endoscopic Sequence 2 of 4.
Gastrointestinal Stromal Tumor (GIST)
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Video Endoscopic Sequence 3 of 4.
Gastrointestinal Stromal Tumor (GIST)
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Video Endoscopic Sequence 4 of 4.
Gastrointestinal Stromal Tumor (GIST)
Because it is a submucosal tumor, biopsies were acquired within the ulcer.
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Video Endoscopic Sequence 1 of 5.
Gastrointestinal Stromal Tumor (GIST)
This 44-year-old male, was hospitalized due to an upper gastrointestinal bleeding. He had previously had two bleeds and two endoscopies at a different clinic. |
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Video Endoscopic Sequence 2 of 5.
Gastrointestinal Stromal Tumor (GIST)
Approach to the large ulcer, there is a visible blood vessel
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Video Endoscopic Sequence 3 of 5.
Tumor del Estroma Gastrointestinal (GIST)
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Video Endoscopic Sequence 4 of 5.
Tumor del Estroma Gastrointestinal (GIST)
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Video Endoscopic Sequence 5 of 5.
Tumor del Estroma Gastrointestinal (GIST)
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Video Endoscopic Sequence 1 of 13.
Gastrointestinal Stromal Tumor (GIST)
The Extraction of the Globe must be carried out in the operation room with EnThis 64 year-old, male due to an abdominal pain, a cat scan was performed finding a large mass in the stomach, an endoscopy was performed; a submucosal mass was detected.
A case of Jejunal GIST is displayed in the Jejunum-Ileum chapter. Also a case of Rectal GIST is in the Miscellaneous chapter.
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Video Endoscopic Sequence 2 of 13.
Gastroscopy showed a large sub mucosal tumor
Gastrointestinal stromal tumour (GIST) is a new termemerging from reclassification of leiomyomas and leiomyosarcomas of the gastrointestinal tract. Histopathological refinement, molecular genetics and immunophenotypic characterization has resulted in better understanding and sub classification of this disease entity.
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Video Endoscopic Sequence 3 of 13.
Endoscopy of Gastrointestinal Stromal Tumor
Gastrointestinal stromal tumors formely classified as leiomyomas or leiomyosarcomas are mesenchymal tumors of the gastrointestinal tract that differ from true Leiomyomas and Leiomyosarcomas. Classification of mesenchymal tumors of the gastrointestinal tract has been the ၳubject of controversies for many years and several histological classification system has been proposed. GIST are now defined as spindle cell, epitheloid or occasionally pleomorphic mesenchymal tumors of the gastrointestinal tract without smooth muscle cell or schwann cell differentiation The term GIST is also limited to tumors originating from pacemaker cell of Cajal located between myenteric plexus cells and smooth muscle cells of the GIT. The immuno-histo chemical marker 'C-Kit' (CD-117) identifies these cell and seems to be the most specific diagnostic marker currently available.
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Video Endoscopic Sequence 4 of 13.
Endoscopic Image of Gastrointestinal Stromal Tumors (GISTs).
Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract.
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Video Endoscopic Sequence 5 of 13.
Endoscopic View of Gastrointestinal Stromal Tumor (GIST)
A palpable abdominal mass is the most frequent presentation but 50% of GISTs are silent until they reach a large size, then causing acute massive hemorrhage into the intestinal tract or peritoneal cavity from tumor rupture. This is the second most common presentation. Other presenting symptoms include nausea, dyspepsia and intestinal obstruction as a result of extrinsic compression.
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Video Endoscopic Sequence 6 of 13.
Resection remains the standard treatment for non-metastatic GISTs. These tumors may have a pseudocapsule and should be removed. Complete resection of GIST is not curative as recurrence is quite common. In patients with local disease, the recurrence rate is 35%. A major diagnostic criterion of GISTs is expression of CD117 and additional criteria include CD34, SMA, S100 and desmin.
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Video Endoscopic Sequence 7 of 13.
Endoscopy of Gastrointestinal Stromal Tumor
GIST:Differential Diagnosis:
Gastrointestinal carcinoid
Adenocarcinoma
Gastric carcinoma
Liposarcoma
Others to be Considered: Angiosarcoma Inflammatory fibroid polyp, Inflammatory myofibroblastic tumor (pseudotumor, fibrosarcoma) intra-abdominal fibromatosis Kaposi sarcoma,Lipoma, Lymphoma, abdominal Melanoma, metastatic Schwannoma, GI.
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Video Endoscopic Sequence 8 of 13.
Endoscopy of Gastrointestinal Stromal Tumor
Endoscopic ultrasound:
Hypoechoic masses that are contiguous with the fourth hypoechoic layer of the GI wall, which corresponds to the muscularis propria
Characteristics associated with malignancy include tumor size greater than 4 cm, an irregular extraluminal border, echogenic foci, and cystic spaces.
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Video Endoscopic Sequence 9 of 13.
In this sequence of images of the computer tomography
shows a large mass inside and outside of the stomach, a
left renal cyst is also seen.
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Video Endoscopic Sequence 10 of 13.
CT is ideal in defining the endoluminal and exophytic extent of tumor.
Smaller GISTs appear as smooth, sharply defined intramural masses with homogenous attenuation.
Larger GISTs with necrosis appear as heterogeneous masses with enhancing borders of variable thickness and irregular central areas of fluid, air, or oral contrast attenuation that reflect necrosis
Occasionally, dense focal calcifications
Overlying mucosal ulcerations and extension into nearby structures may be present.
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Video Endoscopic Sequence 11 of 13.
GIST: benign vrs malignant
Unfortunately, no standard exists for their classification.
Many criteria such as number of mitotic figures, size, presence of necrosis and hemorrhage among others.
Size is the most important and most reliable
Tumor <5 cm is described as having low malignancy potential.
Tumor >5 cm is described as being of high malignancy potential.
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Video Endoscopic Sequence 12 of 13.
Upper GI bleeding is the most common clinical
manifestation of gastrointestinal stromal tumors (GISTs),
manifesting as hematemesis or melena in 40-65% of
patients. Bleeding occurs because of an ulcer forming in
the gastric mucosa overlying the tumor.
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Video Endoscopic Sequence 13 of 13.
Imaging studies, especially CT, play an important role not
only in the detection and the localization but also in the
evaluation of the extension and follow-up of theses tumors.
Small GISTs are intraluminal, localized, and well-defined,
whereas extensive GISTs are large and hypervascular and
may contain cystic and necrotic tumor components
combined with an intra-/extraluminal tumor growth. CT
diagnosis of malignant GISTs can be suggested in the
presence of a large, complex, gastro-intestinal mass,
without significant lymphadenopathy. It is difficult to
differentiate, using only CT imaging, the GIST from other
soft-tissue tumors. In all cases, histological diagnosis is
essential and compulsory.
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Video Endoscopic Sequence 1 of 6.
Enormous Gastric Gastrointestinal Stromal Tumor (GIST) with a central umbilicated ulceration.
A 34 year-old male with hepatic cirrhosis and esophageal varices, presented a submucosal tumor with central umbilicated ulcer. He was asymptomatic at the time of diagnosis. The central location of this ulcer is characteristic for an intramural neoplasm such a GIST.
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Video Endoscopic Sequence 2 of 6.
Endoscopy of Gastrointestinal Stromal Tumor
Grossly, GIST of the stomach most frequently develop in the lower half of the stomach but may also be seen at the fundus. They are usually smaller than 3 cm but occasionally may be large at the time of diagnosis. Ulceration of the mucosa overlying the tumor is reported in 50 – 70% of tumors larger than 2 cm in diameter. Most gastric leiomyomas present as endogastric submucosal lesions and may be pedunculated but some, originatin from the serosa, develop mainly as exogastric masses.
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Video Endoscopic Sequence 3 of 6.
Endoscopy of Gastrointestinal Stromal Tumor
Lateral view of this submucosal tumor.
The classic or usual GI tract GIST has a similar morphologic appearance to leiomyomas in other organs. In the gut, they are usually small, and well circumscribed. The tumors typically arise from the muscularis propria; growth may be intraluminal, extraluminal, or a combination with a dumb-bell shape. GIST can range in size from less than 0.5 cm (microgist) to as large as 30 cm.
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Video Endoscopic Sequence 4 of 6.
Endoscopy of Gastrointestinal Stromal Tumor
Upper endoscopy image showing Gastrointestinal Stromal Tumor (GIST)
Most GIST of stomach are asymptomatic but ulceration may cause pain and signs of gastrointestinal bleeding.
Microscopically, GIST are formed of fasicles of benign-appearing spindle cells without nuclear atypia; mitoses are sparse or absent, and necrosis virtually never occurs. The nucleus is centrally located and oval but may be displaced to one side by distinct vacuoles suggesting signet-ring cells. These vacuoles do not contain fat or mucosubstances, which differentiates them from liposarcomas and carcinomas.
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Video Endoscopic Sequence 5 of 6.
Endoscopy of Gastrointestinal Stromal Tumor
Magnifycation of the tip of the GIST. A Magnifying
endoscope was used.
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Video Endoscopic Sequence 6 of 6.
Endoscopy of Gastrointestinal Stromal Tumor
Some biopsies were taken and proved to be a GIST
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Video Endoscopic Sequence 1 of 3.
Gastric Gastrointestinal Stromal Tumor (GIST)
This 59 year-old, female presented with abdominal pain and melena.
Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal (GI) tract and are thought to develop from the interstitial cells of Cajal, innervated cells associated with the Auerbach plexus. GISTs are typically defined by the expression of c-KIT (CD117) in the tumor cells, as these activating KIT mutations are seen in 85-95% of GISTs. About 3-5% of the remainder of KIT -negative GISTs contain PDGFR alpha mutations.
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Video Endoscopic Sequence 2 of 3.
This image and the video clips shows the diameter of the tumor.
The discovery in 2000 of the efficacy of imatinib, an inhibitor of the BCR-ABL oncoprotein used in the treatment of chronic myeloid leukemia (CML), in treating metastatic gastrointestinal stromal tumor has revolutionized the care of patients with GISTs. Prior to the advent of immunohistochemical methods enabling the specific identification of c-KIT positive tumors, these tumors were inaccurately classified as gastric or intestinal smooth muscle tumors (leiomyomas or leiomyosarcomas).
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Video Endoscopic Sequence 3 of 3.
Note the submucosal tumor mass with the classic features of central umbilication and ulceration.
GISTs are typically diagnosed as solitary lesions, although in rare cases, multiple lesions can be found. These tumors can grow intraluminally or extraluminally toward adjacent structures. When the growth pattern is extraluminal, patients can harbor the disease symptom free for an extended period and present with very large exogastric masses.
Distant metastases tend to appear late in the course of the disease in most cases. In contrast to other soft tissue tumors, the common metastatic sites of GISTs are the liver and peritoneum. Lymph node involvement is rare, occurring in only 0-8% of cases.
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Video Endoscopic Sequence 1 of 9.
Gastrointestinal Stromal Tumor (GIST)
This is a 80 year-old,female who present with upper gastrointestinal hemorrhage, endoscopy found a large ulcerated mass.
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Video Endoscopic Sequence 2 of 9.
Gastroscopy showed a large sub mucosal tumor
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Video Endoscopic Sequence 3 of 9.
Endoscopy of Gastrointestinal Stromal Tumor
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Video Endoscopic Sequence 4 of 9.
Endoscopic Image of Gastrointestinal Stromal Tumor (GISTs)
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Video Endoscopic Sequence 5 of 9.
Endoscopic View of Gastrointestinal Stromal Tumor (GIST)
A palpable abdominal mass is the most frequent presentation but 50% of GISTs are silent until they reach a large size, then causing acute massive hemorrhage into the intestinal tract or peritoneal cavity from tumor rupture. This is the second most common presentation. Other presenting symptoms include nausea, dyspepsia and intestinal obstruction as a result of extrinsic compression.
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Video Endoscopic Sequence 6 of 9.
Endoscopy of Gastrointestinal Stromal Tumor
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Video Endoscopic Sequence 7 of 9.
Endoscopy of Gastrointestinal Stromal Tumor
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Video Endoscopic Sequence 8 of 9.
Gastrointestinal Stromal Tumor (GIST)
Surgical specimen obtained by laparoscopy and assisted endoscopy.
Click on the image to enlarge |
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Video Endoscopic Sequence 9 of 9.
Gastrointestinal Stromal Tumor (GIST)
Surgical specimen obtained by laparoscopy and assisted endoscopy.
Click on the image to enlarge
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Multiple Gastric Gastrointestinal Stromal Tumor (GIST)
A 20 year-old female that have been under anemia screening. Endoscopically multiples gastric leiomiomas in the posterior wall of the stomach from the antrum to the fundus were found. The patient underwent a subtotal gastrectomy and local resection of leiomiomas of the fundus was performed. Medical literature describes five similar cases reported previously.
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Video Endoscopic Sequence 1 of 65.
Gastrointestinal Stromal Tumor (GIST).
This 42 year-old lady who underwent a routine endoscopy, a submucosa mass was found, a laparoscopic resection is performed with the attends of GI endoscopy.
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Video Endoscopic Sequence 2 of 65.
Retroflexed image.
Gastrointestinal stromal tumors (GISTs) are rare.
Nevertheless, some may present with a life-threatening
hemorrhage or intestinal obstruction.
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Video Endoscopic Sequence 3 of 65.
Due to this ulcer some biopsies were taken.
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Video Endoscopic Sequence 4 of 65.
We tried to banding this submucous mass, but due to the size a little greater, we did not continue treating.
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Video Endoscopic Sequence 5 of 65.
Biopsies of great size were taken.
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Video Endoscopic Sequence 6 of 65.
Adrenalin dilution of 1/10000 and 50% Dextrose.
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Video Endoscopic Sequence 7 of 65. |
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Video Endoscopic Sequence 8 of 65. |
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Video Endoscopic Sequence 9 of 65. |
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Video Endoscopic Sequence 10 of 65. |
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Video Endoscopic Sequence 11 of 65.
Patient underwent an assisted laparoscopic resection.
Patient underwent a laparoscopic resection.
This video sequence shows the laparoscopic steps of this
surgery.
The increased use of laparoscopy in the management of
gastrointestinal problems continues to expand. Procedures
such as jejunostomies, diagnosis of intestinal obstruction or
ischemia, resection of the small bowel, and lysis of
adhesions can be managed with this technique.
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Video Endoscopic Sequence 12 of 65.
The surgeon is performing some marks were the exact site of the submucosa mass will be resected.
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Video Endoscopic Sequence 13 of 65.
This video clip shows the light of the laparoscope that transluminate through the gastric mucosa.
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Video Endoscopic Sequence 14 of 65.
Laparoscopic resection was planned after the abdominal
distension subsided. Pneumoperitoneum was established
with a Veress needle. A 5mm trocar was introduced in the
umbilical incision; a 5mm (0°) telescope was introduced and
the other two 5mm ports were inserted under vision – one
in the right midclavicular line and the other in the left
midclavicular line, below the level of the umbilicus.
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Video Endoscopic Sequence 15 of 65.
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Video Endoscopic Sequence 16 of 65.
For many GI malignancies, laparoscopic surgery is safe
and technically feasible, albeit with a somewhat longer
learning curve compared to open surgery. Advanced
procedures are technically demanding and require more
operative time.
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Video Endoscopic Sequence 17 of 65.
Surgery remains the standard for nonmetastatic
gastrointestinal stromal tumors (GISTs). Laparoscopic
surgery should be considered for these tumors as their
biologic behavior lends them to curative resection without
requiring large margins or extensive lymphadenectomies.
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Video Endoscopic Sequence 18 of 65.
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Video Endoscopic Sequence 19 of 65.
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Video Endoscopic Sequence 20 of 65.
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Video Endoscopic Sequence 21 of 65.
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Video Endoscopic Sequence 22 of 65.
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Video Endoscopic Sequence 23 of 65.
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Video Endoscopic Sequence 24 of 65.
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Video Endoscopic Sequence 25 of 65.
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Video Endoscopic Sequence 26 of 65.
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Video Endoscopic Sequence 27 of 65.
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Video Endoscopic Sequence 28 of 65.
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Video Endoscopic Sequence 29 of 65.
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Video Endoscopic Sequence 30 of 65.
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Video Endoscopic Sequence 31 of 65.
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Video Endoscopic Sequence 32 of 65.
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Video Endoscopic Sequence 33 of 65.
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Video Endoscopic Sequence 34 of 65.
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Video Endoscopic Sequence 35 of 65.
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Video Endoscopic Sequence 36 of 65.
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Video Endoscopic Sequence 37 of 65.
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Video Endoscopic Sequence 38 of 65.
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Video Endoscopic Sequence 39 of 65.
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Video Endoscopic Sequence 40 of 65.
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Video Endoscopic Sequence 41 of 64.
Intraoperative video clip showing the linear stampler
applied to the stomach.
Stapled laparoscopic resection is a safe and effective
treatment option for nonmetastatic primary jejunal GIST
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Video Endoscopic Sequence 42 of 64.
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Video Endoscopic Sequence 43 of 64.
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Video Endoscopic Sequence 44 of 64.
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Video Endoscopic Sequence 45 of 64.
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Video Endoscopic Sequence 46 of 64.
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Video Endoscopic Sequence 47 of 64.
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Video Endoscopic Sequence 48 of 64.
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Video Endoscopic Sequence 49 of 64.
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Video Endoscopic Sequence 50 of 64.
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Video Endoscopic Sequence 51 of 64.
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Video Endoscopic Sequence 52 of 64.
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Video Endoscopic Sequence 53 of 64.
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Video Endoscopic Sequence 54 of 64.
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Video Endoscopic Sequence 55 of 64.
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Video Endoscopic Sequence 56 of 64.
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Video Endoscopic Sequence 57 of 64.
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Video Endoscopic Sequence 58 of 64.
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Video Endoscopic Sequence 59 of 65.
Low power: Stromal tumor showing the muscularis
propria of stomach.
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Video Endoscopic Sequence 60 of 65. |
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Video Endoscopic Sequence 61 of 65. |
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Video Endoscopic Sequence 62 of 65. |
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Video Endoscopic Sequence 63 of 65. |
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Video Endoscopic Sequence 64 of 65. |
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Video Endoscopic Sequence 65 of 65. |
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