Lymph node metastasis in gastrointestinal stromal tumours (GIST) occurs preferentially in young patients < or = 40 years: an overview based on our case material and the literature.

PURPOSE: Data on the clinicopathological and biological profiles of gastrointestinal stromal tumours (GISTs) at higher risk for nodal metastasis are lacking.

MATERIALS AND

METHODS

We reviewed our own case material and the relevant English literature.

RESULTS

Regional node metastasis was detected in two of 210 GISTs in our case material (1%) corresponding to 6% of 33 patients with nodal dissection (mean, 11 nodes) and 25% of those < or = 40 years of age. The two patients had a mean age of 32 years, contrasting with a mean age of 65 years for the whole cohort. One of them had incomplete Carney triad with pulmonary chondromas. The literature disclosed a comparable frequency of lymphatic spread among paediatric patients and young adults (approximately 20%), irrespective of the features of the Carney triad. Although a wider age range was reported in isolated reports, a majority (66%) of patients with lymph node metastasis were women < or = 40 years with gastric epithelioid/mixed type ulcerated endoluminal GIST presenting with GI bleeding.

CONCLUSION

Contrasting GISTs in elderly patients, lymphatic spread represents a common route of initial spread in patients < or = 40 with gastric GISTs, suggesting the need for node sampling in this particular subset of GIST patients. The prognostic significance of nodal metastasis in GIST patients remains to be further clarified.