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Tu1156 Feasibility of Watch-and-Wait Strategy for Histological Relapse of Gastric MALT Lymphoma After Helicobacter pylori Eradication Therapy
Tu1156
AGA Abstracts
Feasibility of Watch-and-Wait Strategy for Histological Relapse of Gastric MALT Lymphoma After Helicobacter pylori Eradication Therapy Shinya Kondo, Yasumasa Niwa, Masahiro Tajika, Tsutomu Tanaka, Nobumasa Mizuno, Kazuo Hara, Susumu Hijioka, Hiroshi Imaoka, Yoshikuni Nagashio, Takeshi Ogura, Shin Haba, Toshiyuki Hasegawa, Tomohiko Obayashi, Akihide Shinagawa, Hidemi Goto, Takafumi Ando, Kenji Yamao Background and Aim: Helicobacter pylori is reported to be associated with gastric mucosaassociated lymphoid tissue (MALT) lymphoma. Several studies have shown that 60% to 90% of patients with gastric MALT lymphoma react favorably to H. pylori eradication. However, in cases which have histological relapse of gastric MALT lymphoma after H. pylori eradication, the feasibility of further treatment is not uncertain. Here, the effectiveness of a watch-and-wait strategy for histological relapse of gastric MALT lymphoma after H. pylori eradication therapy is investigated. Methods: The subjects were 100 patients (male:female, 47:53; age range, 26-87 years; median, 56 years) with gastric MALT lymphoma who were seen at our hospital between November 2003 and September 2008. Of these, 78 patients were positive for H. pylori. Biopsy samples were histologically graded according to the scoring system of Wotherspoon. All 100 patients underwent H. pylori eradication therapy, and follow-up was performed by upper gastrointestinal endoscopy, biopsy and abdominal CT every 3 months in the first year, every 4 months in the second year, and at intervals of 6 months in the third year and beyond. Subjects with both macroscopic disappearance of lymphoma and absence of histopathologic evidence of lymphoma on biopsy (grade 1-3 of Wotherspoon's score) were classified as responders. Subjects with biopsy grade of 4-5 on Wotherspoon's score were classified as non-responders. A watch-and-wait strategy without any additional treatment was taken for responders who showed histologically relapsed lesions during follow-up. Results: Following eradication therapy, 39 of 100 patients were classified as non-responders, and most underwent second-line treatments such as radiation therapy, chemotherapy, chemoradiation therapy, or total gastrectomy. Of the 61 responders, 9 showed histologically relapsed lesions during the median follow-up of 78.4 months. The median period from complete histologic remission (CR) to recurrence was 7 months. One subject had a macroscopically relapsed lesion, underwent radiation therapy as a second-line treatment, and achieved a second CR. The remaining 8 subjects had only histologically relapsed lesions and a watch-and-wait strategy was employed. All of these subjects achieved a second CR without any further treatment, and none showed disease progression. The median period from recurrence to second CR was 4.4 months, and the survival rate at 5 years was 100% for responders. Conclusion: The present results suggest that a watch-and-wait strategy is a feasible treatment option for histologically relapsed lesions in responders after H. pylori eradication therapy.
Figure 1. A case of gastrointestinal stromal tumor which underwent mucosal incision assisted biopsy (MIAB). A: Endoscopic image of the lesion. The lesion was covered by normal mucosa with a bridging fold. B: Endoscopic ultrasonography (EUS) imaging of the lesion with a miniature probe. The lesion was located in the 4th layer (muscularis propria). C: Two mucosal incisions were made to expose a portion of the lesion. D: Tissue samples were obtained using biopsy forceps. E: Closure of the mucosal incisions with endoclips. F. Pathological examination of the biopsied specimen. Immunohistochemical analysis showed that the lesion was positive for c-Kit and CD34 and negative for desmin. The biopsy samples also contained normal smooth muscle tissue, which was negative for c-Kit and CD34 and positive for desmin.
Tu1157 Preoperative Tissue Sampling of Suspected Gastric Gastrointestinal Stromal Tumors by Mucosal Incision Assisted Biopsy Eikichi Ihara, Kuniomi Honda, Yoshitaka Hata, Yorinobu Sumida, Hirotada Akiho, Kazuhiko Nakamura, Ryoichi Takayanagi Background and study aim: Endoscopic submucosal dissection (ESD)-associated techniques have been used in Japan for tissue sampling of suspected gastrointestinal stromal tumors (GISTs) instead of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of the present report was to evaluate the diagnostic yield and sensitivity of this procedure, which we named mucosal incision assisted biopsy (MIAB), for the histological diagnosis of gastric submucosal tumor (SMT). Patients and methods: We performed a retrospective review of the 15 patients with suspected gastric GIST who underwent MIAB in our hospitals between January 2010 and March 2011. This technique involved making a mucosal incision in the same way as the circumferential mucosal incision is made for ESD, followed by careful submucosal dissection until a portion of the lesion was exposed, and taking biopsy specimens under direct vision. Results: Tissue samples obtained by MIAB were sufficient for us to make a histological diagnosis of the gastric SMTs in 13 of the 15 patients. There were no significant differences in age, sex, SMT location or SMT size between diagnostic and non-diagnostic MIAB groups of patients, but there was a significant difference in SMT growth patterns between the groups (p < 0.05). Conclusions: Although it is generally accepted that EUSFNA is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.
Tu1158 Radiological Features and Clinical Correlates of Gastrointestinal Stromal Tumors Yasser H. Shaib, Al-Balas Hassan Purpose: To describe the imaging features of gastrointestinal stromal tumors (GIST) and evaluate their reliability in predicting tumor behavior. Material and methods: The medical records and images of all patients diagnosed with GIST in the last 6 years were reviewed. Imaging features were correlated with clinical course and pathological findings. Results: 26 patients were identified. Stomach was the most common site of origin(17 patients, 61%)followed by small bowel (36%) (duodenum=1, jejunum=6 and ileum=3) and one from the omentum . The average size of these tumors at presentation was 7.5 cm's (1-25.5). Nine patients showed distant metastasis and 19 patients had localized disease. Metastases were to the liver in 4 patients, peritoneum in 2 patients and to both in 3 patients. Eighteen patients underwent surgical resection of the primary tumor. High grade histology (more than 5 mitoses per 50 high power fields) was seen in 47% of the patients (9/19). CT scans showed predominantly solid soft tissue masses arising from the gut wall and grew predominantly subserosally (n=20, 81%) or less commonly submucosally (n=5, 19%). In
S-761
AGA Abstracts
AGA Abstracts
Feasibility of Watch-and-Wait Strategy for Histological Relapse of Gastric MALT Lymphoma After Helicobacter pylori Eradication Therapy Shinya Kondo, Yasumasa Niwa, Masahiro Tajika, Tsutomu Tanaka, Nobumasa Mizuno, Kazuo Hara, Susumu Hijioka, Hiroshi Imaoka, Yoshikuni Nagashio, Takeshi Ogura, Shin Haba, Toshiyuki Hasegawa, Tomohiko Obayashi, Akihide Shinagawa, Hidemi Goto, Takafumi Ando, Kenji Yamao Background and Aim: Helicobacter pylori is reported to be associated with gastric mucosaassociated lymphoid tissue (MALT) lymphoma. Several studies have shown that 60% to 90% of patients with gastric MALT lymphoma react favorably to H. pylori eradication. However, in cases which have histological relapse of gastric MALT lymphoma after H. pylori eradication, the feasibility of further treatment is not uncertain. Here, the effectiveness of a watch-and-wait strategy for histological relapse of gastric MALT lymphoma after H. pylori eradication therapy is investigated. Methods: The subjects were 100 patients (male:female, 47:53; age range, 26-87 years; median, 56 years) with gastric MALT lymphoma who were seen at our hospital between November 2003 and September 2008. Of these, 78 patients were positive for H. pylori. Biopsy samples were histologically graded according to the scoring system of Wotherspoon. All 100 patients underwent H. pylori eradication therapy, and follow-up was performed by upper gastrointestinal endoscopy, biopsy and abdominal CT every 3 months in the first year, every 4 months in the second year, and at intervals of 6 months in the third year and beyond. Subjects with both macroscopic disappearance of lymphoma and absence of histopathologic evidence of lymphoma on biopsy (grade 1-3 of Wotherspoon's score) were classified as responders. Subjects with biopsy grade of 4-5 on Wotherspoon's score were classified as non-responders. A watch-and-wait strategy without any additional treatment was taken for responders who showed histologically relapsed lesions during follow-up. Results: Following eradication therapy, 39 of 100 patients were classified as non-responders, and most underwent second-line treatments such as radiation therapy, chemotherapy, chemoradiation therapy, or total gastrectomy. Of the 61 responders, 9 showed histologically relapsed lesions during the median follow-up of 78.4 months. The median period from complete histologic remission (CR) to recurrence was 7 months. One subject had a macroscopically relapsed lesion, underwent radiation therapy as a second-line treatment, and achieved a second CR. The remaining 8 subjects had only histologically relapsed lesions and a watch-and-wait strategy was employed. All of these subjects achieved a second CR without any further treatment, and none showed disease progression. The median period from recurrence to second CR was 4.4 months, and the survival rate at 5 years was 100% for responders. Conclusion: The present results suggest that a watch-and-wait strategy is a feasible treatment option for histologically relapsed lesions in responders after H. pylori eradication therapy.
Figure 1. A case of gastrointestinal stromal tumor which underwent mucosal incision assisted biopsy (MIAB). A: Endoscopic image of the lesion. The lesion was covered by normal mucosa with a bridging fold. B: Endoscopic ultrasonography (EUS) imaging of the lesion with a miniature probe. The lesion was located in the 4th layer (muscularis propria). C: Two mucosal incisions were made to expose a portion of the lesion. D: Tissue samples were obtained using biopsy forceps. E: Closure of the mucosal incisions with endoclips. F. Pathological examination of the biopsied specimen. Immunohistochemical analysis showed that the lesion was positive for c-Kit and CD34 and negative for desmin. The biopsy samples also contained normal smooth muscle tissue, which was negative for c-Kit and CD34 and positive for desmin.
Tu1157 Preoperative Tissue Sampling of Suspected Gastric Gastrointestinal Stromal Tumors by Mucosal Incision Assisted Biopsy Eikichi Ihara, Kuniomi Honda, Yoshitaka Hata, Yorinobu Sumida, Hirotada Akiho, Kazuhiko Nakamura, Ryoichi Takayanagi Background and study aim: Endoscopic submucosal dissection (ESD)-associated techniques have been used in Japan for tissue sampling of suspected gastrointestinal stromal tumors (GISTs) instead of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of the present report was to evaluate the diagnostic yield and sensitivity of this procedure, which we named mucosal incision assisted biopsy (MIAB), for the histological diagnosis of gastric submucosal tumor (SMT). Patients and methods: We performed a retrospective review of the 15 patients with suspected gastric GIST who underwent MIAB in our hospitals between January 2010 and March 2011. This technique involved making a mucosal incision in the same way as the circumferential mucosal incision is made for ESD, followed by careful submucosal dissection until a portion of the lesion was exposed, and taking biopsy specimens under direct vision. Results: Tissue samples obtained by MIAB were sufficient for us to make a histological diagnosis of the gastric SMTs in 13 of the 15 patients. There were no significant differences in age, sex, SMT location or SMT size between diagnostic and non-diagnostic MIAB groups of patients, but there was a significant difference in SMT growth patterns between the groups (p < 0.05). Conclusions: Although it is generally accepted that EUSFNA is the gold standard for obtaining tissue specimens for histological and cytological analysis of suspected gastric GISTs, MIAB can be used as an alternative method for obtaining biopsy specimens of lesions with an intraluminal growth pattern.
Tu1158 Radiological Features and Clinical Correlates of Gastrointestinal Stromal Tumors Yasser H. Shaib, Al-Balas Hassan Purpose: To describe the imaging features of gastrointestinal stromal tumors (GIST) and evaluate their reliability in predicting tumor behavior. Material and methods: The medical records and images of all patients diagnosed with GIST in the last 6 years were reviewed. Imaging features were correlated with clinical course and pathological findings. Results: 26 patients were identified. Stomach was the most common site of origin(17 patients, 61%)followed by small bowel (36%) (duodenum=1, jejunum=6 and ileum=3) and one from the omentum . The average size of these tumors at presentation was 7.5 cm's (1-25.5). Nine patients showed distant metastasis and 19 patients had localized disease. Metastases were to the liver in 4 patients, peritoneum in 2 patients and to both in 3 patients. Eighteen patients underwent surgical resection of the primary tumor. High grade histology (more than 5 mitoses per 50 high power fields) was seen in 47% of the patients (9/19). CT scans showed predominantly solid soft tissue masses arising from the gut wall and grew predominantly subserosally (n=20, 81%) or less commonly submucosally (n=5, 19%). In
S-761
AGA Abstracts