Surgical options in the treatment of GIST of the upper portion of the stomach

Gastrointestinal stromal tumors are rare neoplasms arising from mesenchymal cells of the gastrointestinal tract. These tumors were earlier commonly diagnosed either as leiomyoma, leiomyosarcoma or leiomyoblastoma but it is now evident that GISTs differ from all other mesenchymal neoplasms 1,2. A characteristic feature of GISTs is that they strongly express class III receptor tyrosine kinase, called KIT, in immunohistochemistry due to some mutations in the KIT proto-oncogene 3-6. GISTs probably originate from precursor cells that may differentiate towards the interstitial cells of Cajal, pacemaker cells regulating autonomous motility of G.I. tract 3-6. About two thirds of GISTs are mainly composed of spindle cells (the “spindle cells” variant) and one third of epithelioid or round cells (“the epithelioid variant”), but many mixed forms exist and some GISTs have unusual morpholo gic features 4-7. Two thirds of GISTs are found in the stomach, 20-50% in the small bowel (one third in the duodenum), and 5-15% in colon and rectum; GISTs, however, may rarely be found also in the oesophagus, omentum, mesentery or the retroperitoneum. The distribuition of these tumors in the stomach is: pars media, 40%; antrum, 25%; pylorus, 20%. In less than 15%, GISTs location is next to the EGJ, in the cardia and in the fundus 5,8,9. The Authors describe 2 cases of GIST located just under the upper portion of the stomach and discuss about the different surgical options for GISTs of this region.