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Leiomyosarcomas and GISTs

  1. They most frequently involve the anterior and posterior walls of the gastric fundus.
    They often ulcerate and bleed.
  2. All such tumors should be analyzed for a mutation in the c-kit receptor.
  3. Clinical feature:
    1. Dysphagia
    2. Gastrointestinal Hemorrhage
    3. metastases (mainly in the liver).
  4. Definitive diagnosis of dysphagia made with a biopsy.
  1. GISTs are tumors of connective tissue, i.e. sarcomas;
  2. GISTs arise from interstitial cells of Cajal (ICC),
  3. Even those lesions that appear benign on histologic examination may behave in a malignant fashion.
  4. These tumors rarely invade adjacent viscera and characteristically do not metastasize to lymph nodes, but they may spread to the liver and lungs.
  1. The treatment of choice is surgical resection.
  2. Chemotherapy (imatinib, sunitinib, both  inhibitor of the c-kit tyrosine kinase) are used for patients with metastatic disease.

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