Gastric stromal tumors: clinical presentations, diagnosis and outcome.

OBJECTIVE: To determine the clinical presentations, of gastric stromal tumors with diagnostic methods, pathology and outcome after surgery.

STUDY DESIGN: A case series. DURATION AND SETTING: From January 1988 to December 2002 at The Aga Khan University Hospital, Karachi.

PATIENTS AND METHODS: All patients of age 14 years and above, diagnosed histopathologically to have gastric stromal tumors were included. The data of these patients was collected retrospectively from January 1988 to December 1998, and prospectively from January 1999 to December 2002. All the patients were studied as a single group.

RESULTS: There were 11 patients. Their mean age was 54 years, with 8 males and 3 females. Five patients presented with upper gastrointestinal bleeding, and 4 with lower gastrointestinal bleeding. Eight patients had pain in epigastrium and 2 had vomiting. Upper gastrointestinal endoscopy was done in all patients, and ultrasound was done in 4 patients. CT scan was done in 7 patients. Pre-operative diagnosis could be made in 6 patients. Only one patient had liver metastasis. Wedge resection was performed in 5 proximal gastrectomy with gastroesophageal anastomosis in 3, and partial gastrectomy with gastrojejunostomy in another 3 patients. The mean tumor size was 8.0 centimeters. Two patients had benign, 2 had intermediate and 7 had malignant tumors. The mean duration of follow-up was 41 months. Follow-up was completed in 8 patients, out of whom 6 were alive, and 2 patients expired due to other causes at the time of completion of this study.

CONCLUSION: Gastric stromal tumors are uncommon. Larger gastric stromal tumors are usually symptomatic with gastrointestinal bleeding as a common presentation. Immunohistochemical techniques are required for the diagnosis. Complete surgical resection is the curative therapy.