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Incidental gist in Patients Undergoing Bariatric Surgery: A Systematic Review of Incidence and Management

OBESITY SURGERY 2025年第3期35卷 1009-1017页

作者： Gootee, Jonathan Tham, Elwin Sestito, Michael Abunnaja, Salim Tabone, Lawrence Szoka, Nova Garland-Kledzik, Mary West Virginia Univ Morgantown WV 26506 USA

BackgroundThere has been a rapid increase in prevalence of obesity, and bariatric surgery is the most effective treatment to reduce all-cause mortality. Gastrointestinal stromal tumors (gists) comprise approximately 1% of GI tumors and are the most commonly encountered incidental tumor at the time of bariatric surgery. They have a reported prevalence of approximately 0.5%;however, there are no established guidelines for incidental *** study performed a systematic literature search using PubMed to identify 100 articles from 2005 to 2023 on incidental gist tumors found during bariatric *** prevalence of gists was 0.54% with an average size of 7.04 mm. Management of these lesions should prioritize negative margins with the least invasive resection. Tumors able to be resected without alteration to bariatric surgery should be managed with a complete wedge resection prioritizing negative margins. In tumors where resection requires alteration to bariatric surgical plan, the decision to proceed with resection and alteration of bariatric surgical plan should be made only if previous discussions have been made with patient. Lastly, if resection of the gist precludes the ability to perform the bariatric procedure, consideration to resect the gist with the goal of negative margins should be prioritized with a plan to discuss future bariatric procedures *** goal of this paper is to remind bariatric surgeons to be aware of gists and provide the possible approaches to management.

关键词： gist Bariatric Sleeve Stomach cancer

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gist;a Hand-Book of Missionary Information, Pre-Eminently for Use in Young Women's Circles

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2017年

作者： lilly ryder gracey

gist; a Hand-Book of Missionary Information, Pre-Eminently for Use in Young Women's Circles by Gracey, Lilly Ryder, Ed; published by Cincinnati, Cranston & Curts; New York, Hunt & Eaton

关键词： circles gist hand-book information, missionary missions

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Localized Excision of Gastrointestinal Stromal Tumor (gist) After Sleeve Gastrectomy: Highlighting a Sleeve-Preserving Surgical Approach

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OBESITY SURGERY 2025年第4期35卷 1571-1574页

作者： Khan, Haseeb Javed Yunus, Tahir Ghumman, Abdul Kamil Nimeri, Abdelrahman Evercare Hosp Lahore Pakistan Brigham & Womens Hosp Boston MA USA

BackgroundGastrointestinal stromal tumors (gists) are relatively rare, accounting for approximately 0.1-3% of all gastrointestinal tumors. Their incidence is higher in individuals aged 50 to 70 years, with an equal gender distribution. Due to their diverse clinical presentations, including upper gastrointestinal (GI) bleeding and gastric discomfort, along with an indolent growth pattern, gists can remain undetected for extended periods. This delay in diagnosis can lead to complications. Diagnosis involves upper GI endoscopy, computed tomography (CT) scan, biopsy with histologic grading, and immunohistochemical testing for CD-117 and CD34. The higher incidence of gists in patients with obesity underscores the need for preoperative upper GI endoscopic *** PresentationA 31-year-old female with a history of sleeve gastrectomy (SG) for obesity (BMI 38 kg/m2) presented 13 months postoperatively with recurrent hematemesis, epigastric fullness, and pain radiating to the back. Despite medical management, including proton pump inhibitors (PPIs), her symptoms persisted. Upper GI endoscopy revealed a polypoidal mass at the gastroesophageal junction (GEJ). Endoscopic ultrasound (EUS) indicated that the lesion originated from the muscularis propria. A contrast-enhanced CT scan confirmed the presence of a polypoid mass without extra-luminal extension, raising suspicion of *** patient underwent laparoscopic resection of the tumor using a sleeve-preserving approach. The tumor was excised with a 1-cm margin of normal tissue, ensuring complete resection with negative margins confirmed by the frozen section. The gastric defect was closed with interrupted sutures, and a 38-Fr gastric tube was placed to maintain luminal patency. The patient had an uneventful recovery, with minimal drain output, and was discharged on postoperative day 3 with continued PPI therapy. Histopathological examination confirmed a low-risk gist. At 1-year follow-up, the patient remained asymptomati

关键词： gist Sleeve gastrectomy Sleeve-preserving

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Multiple small bowel gist as GI manifestation of neurofibromatosis type I: A case report

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Radiology case reports 2025年第3期20卷 1548-1551页

作者： Habtamu Tsegaye Adamu Tigabu Department of Radiology School of medicine college of medicine and health science Bahir Dar University Bahir Dar Ethiopia.

Neurofibromatosis type 1 (NF1) is characterized by café-au-lait patches on the skin and the presence of neurofibromas. Gastrointestinal stromal tumor (gist) is the most common GI tumour in NF1 patients. In NF1-associated gist, KIT and PDGFRA mutations are frequently absent and imatinib is ineffective. Surgical resection is first-line treatment. A 58-year-old woman present with dyspepsia symptoms and physical examination was notable for multiple café-au-lait patches and multiple subcutaneous nodular masses of the skin of the face, trunk, and limbs. Abdomininoplevic CT shows multiple different size avidly enhancing small bowel mass. The patient underwent laparotomy and resection with jejenu-jejunal anastomosis was done with smooth post op condition. Histopathology shows Grade I gist with score 4+ immune reactivity for CD117. It is typically difficult to make a conclusive preoperative diagnosis of gists. Computed tomography of the abdomen should be done in Neurofibromatosis type 1 Patients with gastrointestinal symptoms as gists may be the cause of these symptoms. Surgical resection may also be performed for both diagnosis and treatment. The objective of this case repot is to describe the radiological feature of multiple gist in elder NF1 patient in resource limited setup.

关键词： Cutaneous neurofibroma gist Neurofibromatosis Type 1 Radiology features

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Gastrointestinal Stromal Tumor (gist) in the Rectum: A Rare Location

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Journal of Coloproctology 2025年第1期45卷 e1-e5页

作者： Nadab David Mitre-Reyes Yulia Angélica Morales-Chomina Luz del Carmen Mendoza Namur Alan Guerrero-Gomez Kevin Joseph Fuentes-Calvo Moises Freddy Rojas-Illanes Colon and Rectal Surgery Service Siglo XXI High Specialty Medical Unit Instituto Mexicano del Seguro Social CDMX Mexico General Surgery Service High Specialty Medical Unit No. 25 Instituto Mexicano del Seguro Social Monterrey Nuevo León Mexico General Surgery Service Regional General Hospital No.1 Instituto Mexicano del Seguro Social Charo Michoacán Mexico Gastrointestinal Surgery Service Siglo XXI High Specialty Medical Unit Instituto Mexicano del Seguro Social CDMX Mexico General Surgery Service Hospital Médica Sur CDMX Mexico

Gastrointestinal stromal tumor (gist) is a rare condition that originates in the cells of Cajal and constitutes the most frequent type of malignant mesenchymal tumors in the gastrointestinal tract. Although their incidence is low, gists are most common in the stomach and small intestine, although they can occur in other areas, such as the rectum. Although no specific risk factor has been identified, certain genetic conditions such as neurofibromatosis type I increase the likelihood of developing a gist. Symptoms may vary depending on the location of the tumor and include early satiety, abdominal distention, gastrointestinal disturbances, and *** diagnosis is usually made incidentally during radiologic or endoscopic studies and is confirmed by immunohistochemistry studies that identify mutations in cluster of differentiation 117 (c-KIT) and platelet-derived growth factor receptor kinase alpha (PDGRF-α) receptors. These tumors are resistant to conventional chemotherapy and *** of the disease preferably involves surgical resection, aiming for complete removal of the tumor. Prognosis after surgery depends on the size of the tumor and its mitotic activity. Periodic follow-up with imaging tests is recommended for several years after *** advanced cases, treatment may include therapy with imatinib, a tyrosine kinase inhibitor that has demonstrated efficacy in gists. Primary resistance to treatment can be a challenge, and in advanced rectal tumors, several surgical options can be considered, although resection can be difficult due to the location of the tumor and its adherence to the pelvic *** curative resection, recurrence and distant metastasis, especially to the liver, are major concerns, with a reduced median survival in patients with advanced disease.

关键词： Gastrointestinal Stromal Tumor gist rectum surgical resection immunohistochemistry

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Laparoscopic Pancreas-Preserving Duodenal Resection for Duodenal gist

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Annals of surgical oncology 2025年 2025 May 12页

作者： Laura Benuzzi Marco Baia Paolo Cantù Roberto Rosa Melissa Wood Edoardo Baccalini Marco Fiore Chiara Colombo Stefano Radaelli Alessandro Gronchi Dario Callegaro General Surgery Università degli Studi di Milano Milan Italy. laura.benuzzi@unimi.it. Surgery Sarcoma Service Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy. laura.benuzzi@unimi.it. Surgery Sarcoma Service Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy. Gastroenterology and Digestive Endoscopy Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy. Surgery University of Saskatchewan College of Medicine Saskatoon Canada. Department for Continuing Education Kellogg College University of Oxford Oxford UK.

BACKGROUND:Gastrointestinal stromal tumors (gists) are rare mesenchymal neoplasms, commonly arising in the stomach (60-70%) or small intestine (20-30%). Duodenal gists are less common and present unique technical challenges for surgical management. PATIENTS AND METHODS: This video presents the case of a 66-year-old woman with a primary, localized duodenal gist, incidentally discovered in the second portion of the duodenum. Investigations confirmed a 27-mm KIT exon 9-mutated gist. Due to its proximity to the ampulla, preoperative imatinib at 800 mg daily was initiated. After nine months of modest tumor shrinkage, surgery was proposed, but the patient opted to delay due to concerns about surgical morbidity. Given the tumor's stability, imatinib was continued until a laparoscopic resection was performed two years after starting imatinib, preserving both the pancreas and the ampulla. The duodenum was mobilized via a transmesocolic approach, with careful dissection from the pancreatic head. The first jejunal loop was transected, and the duodenum was divided just below the ampulla under direct endoscopic guidance. An intracorporeal, side-to-side, isoperistaltic, antecolic duodenojejunal anastomosis was performed. RESULTS:Complete en-bloc resection with negative margins was achieved. The patient's recovery was uneventful, and she was discharged on postoperative day 7. The length of stay reflects institutional practices influenced by limited home support and patient travel needs. CONCLUSIONS:This case illustrates the value of multidisciplinary planning and minimally invasive techniques for managing duodenal gists. Even with a modest response to imatinib, oncologically sound and anatomically conservative surgery can be achieved.

关键词： Duodenum Endoscopy gist Laparoscopy Pancreas

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gistogram: a graphic presentation of the growing gist complexity

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VIRCHOWS ARCHIV 2013年第4期463卷 481-487页

作者： Ricci, Riccardo Dei Tos, Angelo Paolo Rindi, Guido Univ Cattolica Sacro Cuore Dept Pathol I-00168 Rome Italy Treviso Reg Hosp Dept Pathol I-31100 Treviso Italy

Gastrointestinal stromal tumors (gists) are the most common mesenchymal tumors of the gastrointestinal tract. They have represented a paradigm of molecular-targeted therapies for solid tumors since the discovery of KIT mutations and KIT expression in gist in 1998, which opened the way to the use of imatinib, a tyrosine kinase inhibitor able to inhibit the growth of cells expressing KIT-mutant isoforms. Since then, accumulating evidence revealed the rather heterogeneous nature of gist, implying possible different diagnostic and therapeutic approaches for each specific case, leading to the development of drugs alternative to imatinib. In this brief commentary, we graphically represent the historical growing of genotype and phenotype evidence on gist since 1998 in its increasing complexity by building up a graph, which we have called "gistogram", that visually conveys most of gist-characterizing features and the probability for each of them, either alone or in combination, to be observed in a single gist case.

关键词： gist Genotype Immunophenotype Graph

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gist (Gastro-intestinal stromal tumour) of the gallbladder: a case report

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ACTA CHIRURGICA BELGICA 2004年第1期104卷 107-109页

作者： Peerlinck, IDL Irvin, TT Sarsfield, PTL Harington, JM Royal Devon & Exeter Hosp Dept Surg Exeter EX2 5DW Devon England

The authors report a case of a gastrointestinal stromal tumour (gist) of the gallbladder. gists are rare mesenchymal tumours of the gastrointestinal tract, mesentery and omentum. gists are characterized by the expression of the KIT protein, a transmembrane tyrosine kinase receptor for stem-cell factor. Only a few gists of the gallbladder have been described in the literature. The behaviour of these tumours is not fully understood but long-term survival is rare. Initial treatment consists of aggressive surgery. Radiotherapy and conventional chemotherapy have been mostly unsuccessful. More recently promising studies have been performed with Imatinib, an orally administered tyrosine kinase inhibitor, in patients with advanced disease.

关键词： gallbladder neoplasms ckit pyrimidines imatinib gist jejunal neoplasm

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gist under imatinib therapy

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SEMINARS IN DIAGNOSTIC PATHOLOGY 2006年第2期23卷 84-90页

作者： Sciot, Raf Debiec-Rychter, Maria Katholieke Univ Leuven Dept Pathol Univ Hosp Louvain Belgium Katholieke Univ Leuven Dept Human Genet Univ Hosp Louvain Belgium

The prognosis of patients with a gist improved significantly since the introduction of imatinib mesylate treatment, leading to disease control in 70% to 85% of patients. The response depends on the presence/ absence and type of mutations in the KIT or Platelet derived growth factor receptor. Unfortunately, we are increasingly faced with the problem of resistance to imatinib treatment, mainly secondary resistance, which by definition occurs after at least 6 months of initial response to the drug. The effects of imatinib on a gist are still in full exploration and this review focuses upon the available data on the phenotype and genotype of a gist treated with imatinib. Two settings are elaborated separately, a responding/stable gist, and a resistant gist. In addition, the attention will be drawn to remarkable (immuno)phenotypic changes that can occur in a gist under imatinib treatment. (C) 2006 Elsevier Inc. All rights reserved.

关键词： gist imatinib phenotype genotype treatment effect

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gist:: Particular aspects related to cell cultures, xenografts, and cytogenetics

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SEMINARS IN DIAGNOSTIC PATHOLOGY 2006年第2期23卷 103-110页

作者： Antonio Lopez-Guerrero, Jose Noguera, Rosa Llombart-Bosch, Antonio Univ Valencia Dept Pathol Valencia Spain Fdn Inst Valenciano Oncol Mol Biol Unit Valencia Spain

In less than half a decade, gastrointestinal stromal tumors (gist) have emerged from historical anonymity to become a model of kinase-targeted therapies. Approximately 80% to 85% of gists harbor activating mutations of the KIT or PDGFRA tyrosine kinase genes, and such mutations have predictive and prognostic value. In this regard, the in vitro and in vivo models have provided valuable tools for understanding the molecular pathology of this interesting neoplasm. This review charts particular aspects in the field of cell cultures and tumor xenografts in nude mice in gist and their implication in the establishment of appropriate models for discovering and testing therapy. The cytogenetic features of these tumors are also discussed. Classic karyotyping, loss of heterozygosity, fluorescent in situ hybridization, comparative genomic hybridization (CGH), and CGH-array analyses have shown that chromosomal numerical abnormalities and loss of genetic material at chromosomes 1p, 9p, 14q, and 22q are significantly associated with gist malignancy and response to treatment. Furthermore, these regions constitute "hot" areas for finding candidate genes involved in the pathogenesis of gists. A deeper knowledge of these genetic aspects of gist will provide a better understanding of this neoplasm that could translate into clinical practice. (C) 2006 Elsevier Inc. All rights reserved.

关键词： gist cytogenetics FISH CGH nude mice xenograft

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