Abstract
Between 1963 and 1987, 131 patients with benign gastrointestinal stromal tumors, primarily leiomyomas, were treated at the Massachusetts General Hospital. Eighty per cent of tumors were located in stomach or small intestine. Two thirds of the tumors were discovered in symptomatic patients before operation by a variety of diagnostic studies. A mitotic index (MI) was determined for each tumor, defined as the number of mitoses per 50 high-power microscopic fields. Only gastric and small intestine tumors had MIs more than 2. Tumors were treated by conservative excision in 67% and radical excision in 33%. At a median follow-up of 6 years there were no local recurrences. No patient with a tumor discovered incidentally has recurred. Three symptomatic patients have died of metastatic liver disease. Each patient with recurrence had a tumor with MI of 2 or more, which represents a recurrence rate of 16% in this group. We conclude that symptomatic gastric and small intestine tumors having two or more mitoses per 50 high-power fields carry a significant risk for recurrence, and that routine pathologic assessment of MI may identify a subset of patients who would potentially benefit from close follow-up and consideration for further therapy.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Akwari O. E., Dozois R. R., Weiland L. H., Beahrs O. H. Leiomyosarcoma of the small and large bowel. Cancer. 1978 Sep;42(3):1375–1384. doi: 10.1002/1097-0142(197809)42:3<1375::aid-cncr2820420348>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
- Allen F. A. Leiomyomata of the gastrointestinal tract. J Kans Med Soc. 1971 Nov;72(11):453–457. [PubMed] [Google Scholar]
- Appelman H. D. Smooth muscle tumors of the gastrointestinal tract. What we know now that Stout didn't know. Am J Surg Pathol. 1986;10 (Suppl 1):83–99. [PubMed] [Google Scholar]
- BRUCE A. W., STALKER A. L. Smooth-muscle tumours of the alimentary tract. Br J Surg. 1959 May;46:629–633. doi: 10.1002/bjs.18004620018. [DOI] [PubMed] [Google Scholar]
- Cho K. J., Reuter S. R. Angiography of duodenal leiomyomas and leiomyosarcomas. AJR Am J Roentgenol. 1980 Jul;135(1):31–35. doi: 10.2214/ajr.135.1.31. [DOI] [PubMed] [Google Scholar]
- DARLING R. C., WELCH C. E. Tumors of the small intestine. N Engl J Med. 1959 Feb 26;260(9):397–408. doi: 10.1056/NEJM195902262600901. [DOI] [PubMed] [Google Scholar]
- Farman A. G. Benign smooth muscle tumours. S Afr Med J. 1975 Aug 2;49(33):1333–1340. [PubMed] [Google Scholar]
- Megibow A. J., Balthazar E. J., Hulnick D. H., Naidich D. P., Bosniak M. A. CT evaluation of gastrointestinal leiomyomas and leiomyosarcomas. AJR Am J Roentgenol. 1985 Apr;144(4):727–731. doi: 10.2214/ajr.144.4.727. [DOI] [PubMed] [Google Scholar]
- Ranchod M., Kempson R. L. Smooth muscle tumors of the gastrointestinal tract and retroperitoneum: a pathologic analysis of 100 cases. Cancer. 1977 Jan;39(1):255–262. doi: 10.1002/1097-0142(197701)39:1<255::aid-cncr2820390139>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
- Schmidt A., Lockwood K. Benign neoplasms of the esophagus. Acta Chir Scand. 1967;133(8):640–644. [PubMed] [Google Scholar]
- Schweitzer G. Smooth muscle tumours of the alimentary tract. Aust N Z J Surg. 1967 Feb;36(3):218–222. doi: 10.1111/j.1445-2197.1967.tb05523.x. [DOI] [PubMed] [Google Scholar]
- Stavorovsky M., Morag B., Stavorovsky H., Papo J. Smooth muscle tumors of the alimentary tract. J Surg Oncol. 1983 Feb;22(2):109–114. doi: 10.1002/jso.2930220212. [DOI] [PubMed] [Google Scholar]
- Venkat Rau J. B., Prasada Rao K. R. Gastrointestinal leiomyomas. Am J Gastroenterol. 1975 Mar;63(3):249–251. [PubMed] [Google Scholar]
- Welch J. P. Smooth muscle tumors of the stomach. Am J Surg. 1975 Sep;130(3):279–285. doi: 10.1016/0002-9610(75)90386-4. [DOI] [PubMed] [Google Scholar]