gastrointestinal stroma tumor (gist)

5/25/2018 Gastrointestinal Stroma Tumor (GIST)

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REFERAT

Pembimbing :Dr. Dendy Muhono,

Sp.Rad

Dr. Farid. W. Hafid,

Sp.Rad

Disusun Oleh :

D.S. Putri Nastiti

201210401011051

SMF RADIOLOGI

RSUD JOMBANG

FAKULTAS KEDOKTERAN

UNIVERSITAS

MUHAMMADIYAH MALANG

2014


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Gastrointestinal Stromal Tumors (GIST) 1% dari seluruh kasus tumor gastrointerstinal

Kasus tumor mesenkimal GIT yang paling

sering dijumpai

Lokasi anatomis GIST :gaster (60-70%)

Usus halus (20-25%)

colon dan rectum (5%)

esophagus (


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5000 kasus baru GIST terdeteksi di Amerika Serikat tiap tahun

Islandia, Belanda, Spanyol, dan Swedia : 6.5 sampai 14.5 kasusper 1 juta penduduk

Morbiditas, mortalitas, dan prognosis : tergantung pada

manifestasi klinis dan histopatologis tumor. Rata-rata 5 year

survival rate 28-60%.


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Vague, nyeri abdomen nonspesifik atau discomfort (paling

sering)

Perut terasa penuh atau sensation of abdominal fullness

Massa pada abdomen yang dapat terpalpasi (jarang)

Malaise, fatigue, exertional dyspnea disertai dengan

kehilangan darah signifikan Tanda of peritonitis lokal maupun generalisata (jika ada

perforasi)

Tanda dan gejala obstruktif GIST dapat bersifat spesifik,

tergantung lokasi tumor, antara lain : Dysphagia pada esophageal GIST

Konstipasi, perut kembung, abdominal tenderness pada

colorectal GIST

Obstructive jaundice pada duodenal GIST


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LABORATORIS :

Complete blood cell count

Coagulation profileSerum chemistry studies

BUN and creatinine

Liver function tests and amylase

and lipase values

Type and screen, type and

crossmatchSerum albumin

RADIOLOGIS :

Foto Polos Abdomen (kontras

nonkontras)

CT Scan

USG

MRIPET FDG

EUS


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Foto Polos Abdomen

(non nonkontras)

Nonspecific

May be part of an emergent workup

Abnormal gas patterns, including dilated loops of

bowel or free extraluminal air, may be seen with

bowel obstruction or perforation


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Frequently provides only limitedinformation

Can usually detect GISTs that have

grown to a size sufficient to produce

symptoms

Barium swallow for patients with

dysphagia Barium enema for patients with

constipation, decreased stool caliber, or

colonic manifestations

GISTs appear as an elevated, sharply

demarcated filling defect

The overlying mucosa typically has asmooth contour unless ulceration has

developed

Barium and Air (double contrast)

series :


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CT Scan Abdomen dan Pelvis :

Irregular shape

Heterogeneous density

An intraluminal and extraluminalgrowth pattern

Signs of biological aggression,

sometimes including adjacent

organ infiltration


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Karakteristik CT scan pada tumor

dengan ukuran >10cm :

Irregular margins

Heterogeneous densities Locally aggressive behavior

Distant and peritoneal metastases

Kriteria CT Scan pada tumor dengan

high grade histology dan mortlaitas

tinggi :

Tumor larger than 11.1 cm

Irregular surface contours

Indistinct margins

Adjacent organ invasion

Heterogeneous enhancement

Hepatic or peritoneal metastasis


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Magnetik Resonance

Imaging

Seperti CT Scan, MRI dapat mendeteksi tumor

dan memeberikan informasi mengenai striktur

organ di sekitarnya

Dapat digunakan untuk mendeteksi adanya

tumor nultipel dan metastasis

Sedikit lebih jarang digunakan untuk penegakan

diagnosis GIST, tetapi memiliki tingkat

sensitivitas yang sama

GIST tampak hipointens pada pencitraan

dengan T2-weighted.


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Positron Emission Tomography Scanning dengan 2-[F-

18]-fluoro-2-deoxy-D-glucose :

Untuk mendeteksi metastasis

Monitoring respon pad aterapi ajuvan ( seperti imatinibmesilat )


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Allows localization of lesions and their characterization byultrasonography

Fine-needle aspiration biopsy specimens may be obtained under

sonographic guidance

GISTs typically appear as a hypoechoic mass in the layer

corresponding to the muscularis propria

Complementary with CT More accurate than CT in differentiating benign from malignant

lesions

Allows a more comprehensive evaluation of the mass and the

surrounding structures than CT

Endoscopic Ultrasonography (EUS) :


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Karakteristik EUS pada GIST maligna :

Size larger than 4 cm (the only independent predictor)

Heterogeneous echogenicity

Internal cystic areas

Irregular borders on the extraluminal surfaces

EUS dapat digunakan untuk membedakan GIST gaster dengan leiomyoma,

dengan :

Inhomogenicity

Hyperechogenic spots A marginal halo

Higher echogenicity than the surrounding muscle layer


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Biopsy memberikan definitive diagnosis

Biopsy dibutuhkan pada kasus yang memerlukan terapi

medikamentosa perioperative dan kasus tumor yang tidak

dapat direseksi dengan bedah.

Biopsy tidak perlu dilakukan pada tumor yang dpat direseksi

dengan tindakan bedah dan tidak memerlukan terapimedikamentosa perioperative.


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Kriteria TGM Tumor, Grade, Metastasis

Tumor size (T1, 70 mm; T2, >70 mm; P < .001)

Grade (G1, grades I and II; G2, grades III and IV; P 50 HPFmemiliki perkiraan harapan hidup rata-rata 18 bulan. 80 %

pasien dengan harapan hidup 8 tahun memiliki tumor yang

memunginkan untuk direseksi dan daya mitosis 10/50 HPF.

Klasifikasi risiko (oleh Fletcher et al) :

Very low risk - Smaller than 2 cm and less than 5/50 HPFs

Low risk - From 2-5 cm and less than 5/50 HPFs

Intermediate risk - Either (1) smaller than 5 cm and 6-10/50

HPFs or (2) 5-10 cm and less than 5/50 HPFs

High risk - Includes (1) larger than 5 cm and more than 5/50

HPFs, (2) larger than 10 cm and any mitotic rate, or (3) any

size and more than 10/50 HPFs


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gastrointestinal stroma tumor (gist)

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