Gastrointestinal stromal tumors in patients with neurofibromatosis 1: a clinicopathologic and molecular genetic study of 45 cases.

Am J Surg Pathol

Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Bldg. 54 Rm. G090, Washington, DC 20306-6000, USA.

Published: January 2006

AI Article Synopsis

  • Gastrointestinal stromal tumors (GISTs), often linked to mutations in KIT or PDGFRA, are more likely to develop in patients with neurofibromatosis 1 (NF1), with a study analyzing 45 NF1 patients revealing a median age of 49 years.
  • Most GISTs were small and located in the jejunum or ileum, with common symptoms being gastrointestinal bleeding and anemia, and 5 out of 35 patients with follow-up died from metastatic disease, typically linked to larger tumors.
  • Interestingly, none of the tumors in NF1 patients had the typical mutations associated with sporadic GISTs, suggesting a different underlying cause of these tumors in NF1 patients.

Article Abstract

Gastrointestinal stromal tumors (GISTs), the specific KIT- or PDFGRA-signaling driven mesenchymal tumors, most commonly occur sporadically, but there seems to be some increased tendency for these tumors to develop in patients with neurofibromatosis 1 (NF1). The clinicopathologic profile, KIT, and PDGFRA mutation status and long-term prognosis of patients with GIST in NF1 are incompletely characterized. In this study, we analyzed 45 patients who had NF1 and GIST. There were 26 females and 19 males with a median age of 49 years (10 years lower than the median age of GIST patients in general). A great majority of tumors occurred in the jejunum or ileum, with multiple tumors occurring in 28 cases. Ten patients had a duodenal and one had a gastric GIST. The most common presentations were gastrointestinal bleeding and anemia, and many patients had intermittent bleeding over several years. The majority of the tumors were small and mitotically inactive; only 7 had mitotic activity >5/50 HPFs and 15 tumors were >5 cm. Associated Cajal cell hyperplasia was common. One patient had an intraabdominal peri-intestinal neurofibroma. Five of 35 patients with follow-up died of metastatic disease; all of these had a tumor >5 cm, mitotic rate >5/50 HPFs, or both; three of these tumors were located in the duodenum. The presence of multiple small tumors was not associated with progressive disease. Most patients with long-term follow-up enjoyed a good prognosis; 2 died of other NF1-associated tumors (malignant peripheral nerve sheath tumors, brain tumor). None of the 16 tumors from 15 patients had a KIT exon 9, 11, 13, or 17 or PDGFRA exon 12 or 18 mutation as is typically seen in sporadic GISTs, indicating that GISTs in NF1 patients have a different pathogenesis than sporadic GISTs.

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Source
http://dx.doi.org/10.1097/01.pas.0000176433.81079.bdDOI Listing

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