Σταδιοποίηση σε Ca GIST

Ca GIST – GI Stromal Tumor

AJCC Stages – Στομάχου

Stages

T

N

M

G

IA

T1

N0

M0

G1

T2

N0

M0

G1

IB

T3

N0

M0

G1

II

T1

N0

M0

G2

T2

N0

M0

G2

T4

N0

M0

G1

IIIA

T3

N0

M0

G2

IIIB

T4

N0

M0

G2

IV

Any T

N1

M0

Any G

Any T

Any N

M1

Any G

The AJCC stage grouping schema are slightly different for gastric and small bowel GISTs, owing to slightly different biological activities. The staging for gastric GIST should also be used for omentum.

AJCC Stages – Λεπτού εντέρου

Stages

T

N

M

G

I

T1 or T2

N0

M0

G1

II

T3

N0

M0

G1

IIIA

T1

N0

M0

G2

T4

N0

M0

G1

IIIB

T2

N0

M0

G2

T3

N0

M0

G2

T4

N0

M0

G2

IV

Any T

N1

M0

Any G

Any T

Any N

M1

Any G

The small bowel GIST staging grouping may be applied to esophageal, duodenal, colorectal, and peritoneal GISTs. As there is only minimal data regarding extragastrointestinal GISTs, precise grouping of these rare tumors can be problematic. In cases of extragastrointestinal GISTs and other less common varieties, the staging grouping for small bowel tumors may be used. The T, N, and M criteria reflect imaging findings, whereas tumor grading (G) is based on histologic criteria.

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤ 2 cm

T2

Tumor > 2 cm but ≤ 5 cm

T3

Tumor > 5 cm but ≤ 10 cm

T4

Tumor > 10 cm

Size of tumor is measured in the greatest dimension.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Histologic grade cannot be assessed

G1

Low grade (mitotic rate ≤ 5 per 50 high-power fields)

G2

High grade (mitotic rate > 5 per 50 high-power fields)

Prognostic Grouping

Malignancy Risk

Size Criteria

Histologic Criteria

Very low risk

< 2 cm

≤ 5 per 50 HPF

Low risk

2-5 cm

≤ 5 per 50 HPF

Intermediate risk

< 5 cm

6-10 per 50 HPF

5-10 cm

≤ 5 per 50 HPF

High risk

> 5 cm

> 5 per 50 HPF

> 10 cm

Any mitotic rate

Any size

> 10 per 50 HPF

From Levy AD et al: Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics. 23(2):283-304, 2003. 
This system for stratification of aggressive potential in tumors without known metastatic disease was widely used prior to the advent of AJCC TNM staging system and has now been replaced. Size is measured in the greatest dimension. Histologic criteria reflects the number of mitotic figures per 50 high-power fields (HPF).

Χαρακτηριστικά Επέκτασης

Local spread

• Transperitoneal spread
  • Common pattern of spread, may occur early
• Invasion of surrounding structures
  • Less common than peritoneal seeding

Distant metastasis

• Most commonly metastasizes to liver

Nodal metastasis

• Very rare in GIST
• More likely to occur in women and patients < 40 years old
• More common in gastric epithelioid/mixed-type ulcerated endoluminal GIST

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Soft tissue sarcoma, distinct from leiomyoma/leiomyosarcoma and nerve sheath tumors