Introduction : Gastrointestinal stromal tumors (GIST) constitute a rare subset of digestive tract malignancies classified within the sarcoma group. The objective of this study was to describe the epidemiological, therapeutic, and prognostic characteristics of GISTs and to determine factors associated with poor outcomes in a developing country context. Patients and Methods : A retrospective, descriptive study was conducted over a seven-year period (January 2016 to December 2022) in the Onco-hematology Department of Dalal Jamm National Hospital Center, Senegal. All patients with a diagnosis of GIST confirmed by histological and immunohistochemical analysis were included. Data were extracted from medical charts, operative records, pathology, and immunohistochemistry reports, and analyzed using Sphinx software version 23. Results : Fifty-seven cases of GIST were identified, corresponding to an average annual hospital incidence of eight cases. The mean age of patients was 56 years (range: 29 - 80), with a sex ratio (M/F) of 1.03. The stomach represented the predominant tumor site (54.32%), followed by the mesentery (19%). Abdominal pain was the most frequent presenting symptom (64.91%). Upper gastrointestinal endoscopy revealed endophytic lesions in 24.56% of patients, while computed tomography demonstrated exophytic growth in 87.72%. The mean tumor size was 16.5 cm (range: 2.9 - 31 cm). Spindlecell morphology predominated histologically (92.08%), and C-kit positivity was observed in 70.17% of cases. According to the AFIP classification, available for 33 patients (57.89%), a high risk of recurrence was noted in 36.36%. All patients received imatinib therapy. Surgical management was performed in 54.40% of cases, and one patient underwent full-thickness endoscopic resection. After a mean follow-up of 27.9 months, complete remission was maintained in 24.56% of patients. Mortality occurred in 28.07% and tumor recurrence in 21.05% of cases. Conclusion : GIST remain uncommon in our setting. Diagnostic delays and limited access to comprehensive management significantly affect patient prognosis. The high recurrence rate underscores the need to improve availability of advanced targeted therapies in resource-limited environments.
KeywordsGISTDog 1CKITImatinibProgression
Ahmadou, I.A. (2016) Gastrointestinal Stromal Tumors: Epidemiological-Clinical Aspect, Diagnosis and Therapy at CHU-Gabriel Toure. Thesis, University of Sciences, Techniques and Technologies of Bamako. https://www.bibliosante.ml/handle/123456789/5295
Fletcher, C.D.M., et al . (2002) Tumor Diagnosis Gastrointestinal Stromals: A Approach Consensus.
Fernández, J.Á., Gómez-Ruiz, Á.J., Olivares, V., Ferri, B., Frutos, M.D., Soria, T., et al . (2018) Clinical and Pathological Features of “Small” GIST (≤ 2 cm). What Is Their Prognostic Value? European Journal of Surgical Oncology , 44, 580-586. https://doi.org/10.1016/j.ejso.2018.01.087
Fall, F., Ndiaye, B., Ndiaye, A.R., Diagne Guèye, N.M., Gning, S.B., Niang, A., et al . (2011) Digestive Stromal Tumors (GIST): Retrospective Study of Ten Cases in Senegal. Journal Africain d ’ Hépato - Gastroentérologie , 5, 210-213. https://doi.org/10.1007/s12157-011-0290-2
Miettinen, M., Sobin, L.H. and Sarlomo-Rikala, M. (2000) Immunohistochemical Spectrum of GISTs at Different Sites and Their Differential Diagnosis with a Reference to CD117 (KIT). Modern Pathology , 13, 1134-1142. https://doi.org/10.1038/modpathol.3880210
Nishida, T. and Hirota, S. (2000) Biological and Clinical Review of Stromal Tumors in the Gastro-Intestinal Tract. Histology & Histopathology , 15, 1293-1301.
Boudabous, H., Chaker, Y., Nouira, R. and Dziri, C. (2013) Stromal Gastrointestinal Tumors: Retrospective Study of 24 Cases. La Tunisie Médicale , 91, 661-667.
Tran, T., Davila, J.A. and El-Serag, H.B. (2005) The Epidemiology of Malignant Gastrointestinal Stromal Tumors: An Analysis of 1,458 Cases from 1992 to 2000. The American Journal of Gastroenterology , 100, 162-168. https://doi.org/10.1111/j.1572-0241.2005.40709.x
Chan, K.H., Chan, C.W., Chow, W.H., et al . (2006) Gastrointestinal Stromal Tumors in a Cohort of Chinese Patients in Hong Kong. World Journal of Gastroenterology , 12, 2223-2228. https://doi.org/10.3748/wjg.v12.i14.2223
Taoufiq, N., Naim, A., Bouchbika, Z., Benchekroune, N., Jouhadi, H., Sahraoui, S., et al . (2017) Gastrointestinal Stromal Tumors “GIST”: Status and Updates through Our Experience on 54 Cases and a Literature Review. Pan African Medical Journal , 27, Article No. 165. https://doi.org/10.11604/pamj.2017.27.165.7754
Clère, F., Carola, E., Halimi, C., de Gramont, A., Bonvalot, S., Panis, Y., et al . (2002) Updates on Gastrointestinal Stromal Tumors: Based on Seven Observations of Malignant Tumors. La Revue de Médecine Interne , 23, 499-507. https://doi.org/10.1016/s0248-8663(02)00605-7
Landi, B., Bouché, O., Guimbaud, R. and Chayvialle, J.A. (2010) Gastrointestinal Stromal Tumors (GIST) < 5 cm in Size: Review of the Literature and Expert Proposals for Clinical Management. Gastroentérologie Clinique et Biologique , 34, 120-133. https://doi.org/10.1016/j.gcb.2009.06.019
Ríos-Moreno, M.J., Jaramillo, S., Pereira Gallardo, S., Vallejo, A., Mora, M., García-Escudero, A., et al . (2012) Gastrointestinal Stromal Tumors (GISTs): CD117, DOG-1 and PKC θ Expression. Is There Any Advantage in Using Several Markers? Pathology — Research and Practice , 208, 74-81. https://doi.org/10.1016/j.prp.2011.11.006
Søreide, K., Sandvik, O.M., Søreide, J.A., Giljaca, V., Jureckova, A. and Bulusu, V.R. (2016) Global Epidemiology of Gastrointestinal Stromal Tumours (GIST): A Systematic Review of Population-Based Cohort Studies. Cancer Epidemiology , 40, 39-46. https://doi.org/10.1016/j.canep.2015.10.031
Miettinen, M. and Lasota, J. (2006) Gastrointestinal Stromal Tumors: Pathology and Prognosis at Different Sites. Seminars in Diagnostic Pathology , 23, 70-83. https://doi.org/10.1053/j.semdp.2006.09.001
Cassier, P.A., Ducimetière, F., Lurkin, A., Ranchère-Vince, D., Scoazec, J., Bringuier, P., et al . (2010) A Prospective Epidemiological Study of New Incident GISTs during Two Consecutive Years in Rhône Alpes Region: Incidence and Molecular Distribution of GIST in a European Region. British Journal of Cancer , 103, 165-170. https://doi.org/10.1038/sj.bjc.6605743
Wang, M., Xu, J., Zhang, Y., Tu, L., Qiu, W.Q., Wang, C.J., et al . (2014) Gastrointestinal Stromal Tumor: 15-Years’ Experience in a Single Center. BMC Surgery , 14, Article No. 93. https://doi.org/10.1186/1471-2482-14-93
Beham, A., Schaefer, I., Cameron, S., von Hammerstein, K., Füzesi, L., Ramadori, G., et al . (2012) Duodenal GIST: A Single Center Experience. International Journal of Colorectal Disease , 28, 581-590. https://doi.org/10.1007/s00384-012-1432-8
Nacireddine, N., Sabbah, F., Ahallat, M. and Bouklata, S. (2012) Tumor Imaging Gastrointestinal Stromals. Feuillets de Radiologie , 52, Article No. 361. https://doi.org/10.1016/j.frad.2012.07.001
Lin, M., Lin, J.X., Huang, C.M., Zheng, C.H., Li, P., Xie, J.W., et al . (2014) Prognostic Analysis of Gastric Gastrointestinal Stromal Tumor with Synchronous Gastric Cancer. World Journal of Surgical Oncology , 12, Article No. 25. https://doi.org/10.1186/1477-7819-12-25
Dematteo, R.P., Heinrich, M.C., El-Rifai, W.M. and Demetri, G. (2002) Clinical Management of Gastrointestinal Stromal Tumors: Before and after STI-571. Human Pathology , 33, 466-477. https://doi.org/10.1053/hupa.2002.124122
Ahmed, I., Welch, N.T. and Parsons, S.L. (2008) Gastrointestinal Stromal Tumours (GIST)-17 Years Experience from Mid Trent Region (United Kingdom). European Journal of Surgical Oncology , 34, 445-449. https://doi.org/10.1016/j.ejso.2007.01.006
Landi, B., Lecomte, T., Berger, A. and Cellier, C. (2004) Clinical Management of Gastrointestinal Stromal Tumors. Gastroentérologie Clinique et Biologique , 28, 893-901. https://doi.org/10.1016/s0399-8320(04)95154-8
Duffaud, F., Meeus, P., Bachet, J.B., Cassier, P., Huynh, T.K., Boucher, E., et al . (2014) Conservative Surgery vs. Duodeneopancreatectomy in Primary Duodenal Gastrointestinal Stromal Tumors (GIST): A Retrospective Review of 114 Patients from the French Sarcoma Group (FSG). European Journal of Surgical Oncology , 40, 1369-1375. https://doi.org/10.1016/j.ejso.2014.04.011
Coe, T.M., Fero, K.E., Fanta, P.T., Mallory, R.J., Tang, C., Murphy, J.D., et al . (2016) Population-Based Epidemiology and Mortality of Small Malignant Gastrointestinal Stromal Tumors in the USA. Journal of Gastrointestinal Surgery , 20, 1132-1140. https://doi.org/10.1007/s11605-016-3134-y
Hassan, I., You, Y.N., Dozois, E.J., Shayyan, R., Smyrk, T.C., Okuno, S.H., et al . (2006) Clinical, Pathologic, and Immunohistochemical Characteristics of Gastrointestinal Stromal Tumors of the Colon and Rectum: Implications for Surgical Management and Adjuvant Therapies. Diseases of the Colon & Rectum , 49, 609-615. https://doi.org/10.1007/s10350-006-0503-8