Current clinical management of gastrointestinal stromal tumor

Figure 1 Rate of metastasis or tumor-related death according to tumor diameter and mitotic index. Created using reference[6].

Figure 2 Flow chart of diagnosis of gastrointestinal mesenchymal tumors using immunohistochemical or genetic analysis. ¹Solitary fibrous tumors should be ruled out. Quoted and modified from reference[8]. GIST: Gastrointestinal stromal tumor.

Figure 3 Endoscopic images of subepithelial lesions that can be diagnosed only with endoscopic ultrasound findings and their specific endoscopic ultrasonography images. A: Endoscopic image of a gastric lipoma (arrow); B: Endoscopic ultrasound (EUS) image of A (high-echo mass); C: Endoscopic image of a gastric cyst; D: EUS image of C (anechoic mass); E: Endoscopic image of extra-gastric compression due to splenic artery aneurysm; F: EUS image of E [normal gastric wall is compressed by a splenic artery aneurysm(SAA) (arrow). SA: splenic artery]; G: Endoscopic image of gastric varices (arrow); H: EUS image of G [varices are present in the submucosa from the outside of the wall (V) (arrow)]. Quoted and modified from reference[38] with permission.

Figure 4 Differential diagnosis of subepithelial lesions by endoscopic ultrasound. Quoted and modified from reference[39] with permission. GIST: Gastrointestinal stromal tumor.

Figure 5 Endoscopic ultrasound images and corresponding endoscopic ultrasonography-guided fine needle aspiration specimens of hypoechoic solid tumors. A: Endoscopic ultrasound (EUS) image of a gastric gastrointestinal stromal tumor; B: EUS-guided fine needle aspiration (EUS-FNA) specimen tissue image of A (KIT-positive spindle-shaped tumor cells are observed); C: EUS image of gastric leiomyoma; D: EUS-FNA specimen tissue image of C [α-SMA-positive spindle-shaped tumor cells are observed; diagnosis of leiomyoma was made by immunohistochemical analysis, which revealed α-SMA (+), KIT (-), CD34 (-), and S-100 (-)]; E: EUS image of gastric malignant lymphoma; F: EUS-FNA specimen image of E (diagnosis of diffuse large B-cell lymphoma was made by CD20-positive lymphoid tumor cells); G: EUS image of rectal neuroendocrine tumor (NET); H: EUS-FNA specimen image of G (diagnosis of NET was made by typical findings of irregular nest of synaptophysin-positive epithelial-like cells). Quoted and modified from reference[38] with permission.

Figure 6 Proposed algorithm for management of subepithelial lesions. Quoted and modified from reference[21]. GIST: Gastrointestinal stromal tumor; GI: Gastrointestinal; SEL: Subepithelial lesion; EUS: Endoscopic ultrasound; EUS-FNA: Endoscopic ultrasound-guided fine needle aspiration.

Figure 7 Laparoscopic resection of a small gastric gastrointestinal stromal tumor. A: Laparoscopic view of a small gastric gastrointestinal stromal tumor (arrow) during resection; B: Postoperative endoscopy shows mild postoperative deformity (arrow). Quoted and modified from reference[77] with permission.

Figure 8 Contour maps for estimating the risk of gastrointestinal stromal tumor recurrence after surgery. Areas of colors according to the recurrence rate at the 10^th year after surgical treatment of GIST: Blue-black: 0%-10%, Blue: 10%-20%, Light blue: 20%-40%, Gray: 40%-60%, Pink: 60%-80%, Red: 80%-90%, Dark red: 90%-100%. Reprinted from reference[87] with permission. E-GIST: Extra-gastrointestinal stromal tumor (arising outside the gastrointestinal tract).