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2018, Volume 34, Number 3, Page(s) 207-214     
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DOI: 10.5146/tjpath.2018.01427
Gastrointestinal Stromal Tumors: A Clinicopathological and Immunohistochemical Study of 65 Cases
Merih TEPEOĞLU1, Gonca ÖZGÜN1, M. Zeyneb TUNCA1, Tugan TEZCANER2, B. Handan ÖZDEMIR1
1Department of Pathology,Başkent University Faculty of Medicine, ANKARA, TURKEY
2Department of General Surgery, Başkent University Faculty of Medicine, ANKARA, TURKEY
Keywords: Gastrointestinal stromal tumors, Necrosis, Ki-67, CD-34

Objective: The clinical behavior of gastrointestinal stromal tumors is divergent. The aim of the present study was to define the clinicopathological features that determine the patient’s outcome.

Material and Method: Sixty-five gastrointestinal stromal tumors were reviewed with their histological, immunohistochemical and clinical features and compared with their clinical outcome statistically.

Results: Tumors were located in the stomach (n=39, 60%), small intestine (n=22, 33.8%) and large intestine (n=4, 6.2%). Immunohistochemically, CD 117 positivity was found in 90.8%, whereas CD34, Smooth muscle actin, Desmin and S100 positivity was found in 73.3%, 61.7%, 11.7% and 28.3% of tumors respectively. All six ‘‘CD 117-negative’’ cases expressed DOG-1. The mean Ki-67 proliferation index was 8.69%±12.76. Liver metastasis was detected in seven cases. A significant association was detected between decreased mean survival time and increased tumor size (p<0.001), large bowel localization (p=0.047), mitosis (p<0.001), the presence of necrosis (p=0.001), metastasis (p=0.033), Ki-67 proliferation index (p=0.002) and risk category (p<0.001). CD 34 positivity was mostly seen in the stomach (p=0.001), and CD 34 positive tumors had longer overall survival (92.85.±5.77 months versus 67.21±13.68 months) (p=0.046). Higher Ki-67 proliferation index (≥6%) was also correlated with the presence of metastases (p=0.015).

Conclusion: Our study indicates that in addition to well-known risk factors such as increased tumor size, high mitotic activity and metastasis; higher Ki-67 proliferation index, the presence of necrosis, and CD34 negativity also correlate with shorter survival time.

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