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Review
. 2017 Sep;24(5):259-267.
doi: 10.1097/PAP.0000000000000158.

What is New in Gastrointestinal Stromal Tumor?

Affiliations
Review

What is New in Gastrointestinal Stromal Tumor?

Inga-Marie Schaefer et al. Adv Anat Pathol. 2017 Sep.

Abstract

The classification "gastrointestinal stromal tumor" (GIST) became commonplace in the 1990s and since that time various advances have characterized the GIST lineage of origin, tyrosine kinase mutations, and mechanisms of response and resistance to targeted therapies. In addition to tyrosine kinase mutations and their constitutive activation of downstream signaling pathways, GISTs acquire a sequence of chromosomal aberrations. These include deletions of chromosomes 14q, 22q, 1p, and 15q, which harbor putative tumor suppressor genes required for stepwise progression from microscopic, preclinical forms of GIST (microGIST) to clinically relevant tumors with malignant potential. Recent advances extend our understanding of GIST biology beyond that of the oncogenic KIT/PDGFRA tyrosine kinases and beyond mechanisms of KIT/PDGFRA-inhibitor treatment response and resistance. These advances have characterized ETV1 as an essential interstitial cell of Cajal-GIST transcription factor in oncogenic KIT signaling pathways, and have characterized the biologically distinct subgroup of succinate dehydrogenase deficient GIST, which are particularly common in young adults. Also, recent discoveries of MAX and dystrophin genomic inactivation have expanded our understanding of GIST development and progression, showing that MAX inactivation is an early event fostering cell cycle activity, whereas dystrophin inactivation promotes invasion and metastasis. VSports手机版.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to disclose V体育安卓版. This work was supported by US National Institutes of Health grants 1P50CA127003 (JAF) and 1P50CA168512 (JAF, AME), and by the GIST Cancer Research Fund (JAF).

"V体育官网入口" Figures

Figure 1
Figure 1
Distribution of primary KIT and PDGFRA tyrosine kinase mutations in GIST.
Figure 2
Figure 2
Overview of the frequency of the molecular subtypes of GIST.
Figure 3
Figure 3
Typical histologic features in GIST. A KIT-mutant GIST with sheet-like, solid growth (A) showing expression of DOG-1 (A, inset), SDHB (B), and SDHA (C). In contrast, SDH-deficient GISTs exhibit characteristic multinodular growth pattern at low power (D), are positive for DOG-1 (D, inset) and lack SDHB expression (E). In this case, SDHA expression (F) is retained, indicating the GIST arises from mutation of SDHB, SDHC or SDHD, rather than SDHA. Another example of an SDH-deficient GIST showing the characteristic epithelioid morphology (G) and expression of DOG-1 (G, inset) with SDHB (H) and SDHA (I) loss of expression indicating an underlying SDHA mutation; vessels (bottom left) serve as positive internal control.
Figure 4
Figure 4
Model of GIST genomic progression. Primary KIT, PDGFRA or NF1 mutations represent the initiating oncogenic driver events in most GISTs and are followed by stepwise accumulation of chromosomal aberrations, harboring putative tumor suppressor genes, and cell cycle dysregulating events. Metastatic GISTs develop treatment resistance through evolving TKI-resistant subclones with additional secondary KIT or PDGFRA mutations.
Figure 5
Figure 5
A metastatic GIST (A) without MAX or p16/INK4A coding region deletion with retained expression of MAX (B) and p16 (C); Another metastatic GIST (D) with homozygous MAX deletion and without p16/INK4A coding region deletion shows loss of MAX (E) and p16 (F) expression; vessels and inflammatory cells serve as positive internal controls. Dystrophin immunohistochemistry (using the DYS-A antibody) shows predominantly membranous expression in normal skeletal muscle (G). A GIST with retained expression of dystrophin (H) and another GIST showing loss of dystrophin expression (I); infiltrated smooth muscle cells (bottom left) serve as positive internal control.

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