Log in

Clinical and molecular characteristics of gastrointestinal stromal tumors in the pediatric and young adult population

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Gastrointestinal stromal tumors (GISTs) typically occur late in life; however, there also are reports of pediatric and young adult patients. This rare subset of GISTs has clinicopathologic and molecular features distinct from their adult counterparts. Most pediatric GIST patients are female and often present with multifocal tumors that are epithelioid in nature. Although these young patients often have metastatic disease, it progresses slowly. Most pediatric GISTs lack the gain-of-function mutation in KIT or PDGFRA commonly found in adult cases. Expression profiling and genomic studies of pediatric GISTs show distinct molecular signatures, suggesting a unique origin as compared with adult GISTs. We and others have shown that the insulin-like growth factor 1 receptor may have a prominent role in driving KIT/PDGFRA mutation-negative adult and pediatric GISTs, and clinical trials are currently being designed to exploit these types of discoveries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Corless CL, Heinrich MC: Molecular pathobiology of gastrointestinal stromal sarcomas. Annu Rev Pathol 2007, 3:557–586.

    Article  Google Scholar 

  2. Mazur MT, Clark HB: Gastric stromal tumors. Reappraisal of histogenesis. Am J Surg Pathol 1983, 7:507–519.

    Article  PubMed  CAS  Google Scholar 

  3. Rubin BP: Gastrointestinal stromal tumours: an update. Histopathology 2006, 48:83–96.

    Article  PubMed  CAS  Google Scholar 

  4. Sircar K, Hewlett BR, Huizinga JD, et al.: Interstitial cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol 1999, 23:377–389.

    Article  PubMed  CAS  Google Scholar 

  5. Kindblom LG, Remotti HE, Aldenborg F, et al.: Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998, 152:1259–1269.

    PubMed  CAS  Google Scholar 

  6. El-Rifai W, Sarlomo-Rikala M, Andersson LC, et al.: DNA sequence copy number changes in gastrointestinal stromal tumors: tumor progression and prognostic significance. Cancer Res 2000, 60:3899–3903.

    PubMed  CAS  Google Scholar 

  7. Tworek JA, Appelman HD, Singleton TP, et al.: Stromal tumors of the jejunum and ileum. Mod Pathol 1997, 10:200–209.

    PubMed  CAS  Google Scholar 

  8. Tworek JA, Goldblum JR, Weiss SW, et al.: Stromal tumors of the anorectum: a clinicopathologic study of 22 cases. Am J Surg Pathol 1999, 23:946–954.

    Article  PubMed  CAS  Google Scholar 

  9. Miettinen M, Monihan JM, Sarlomo-Rikala M, et al.: Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol 1999, 23:1109–1118.

    Article  PubMed  CAS  Google Scholar 

  10. Fang FC, Tzao C, Cheng YL, et al.: Surgical treatment of gastrointestinal stromal tumor in the esophagus: report of three cases. Z Gastroenterol 2007, 45:1252–1256.

    Article  PubMed  Google Scholar 

  11. Tarn C, Merkel E, Canutescu AA, et al.: Analysis of KIT mutations in sporadic and familial gastrointestinal stromal tumors: therapeutic implications through protein modeling. Clin Cancer Res 2005, 11:3668–3677.

    Article  PubMed  CAS  Google Scholar 

  12. DeMatteo RP, Lewis JJ, Leung D, et al.: Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000, 231:51–58.

    Article  PubMed  CAS  Google Scholar 

  13. Demetri GD, von Mehren M, Blanke CD, et al.: Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002, 347:472–480.

    Article  PubMed  CAS  Google Scholar 

  14. Debiec-Rychter M, Sciot R, Le Cesne A, et al.: KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours. Eur J Cancer 2006, 42:1093–1103.

    Article  PubMed  CAS  Google Scholar 

  15. Miettinen M, Lasota J, Sobin LH: Gastrointestinal stromal tumors of the stomach in children and young adults: a clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases with long-term follow-up and review of the literature. Am J Surg Pathol 2005, 29:1373–1381.

    Article  PubMed  Google Scholar 

  16. Prakash S, Sarran L, Socci N, et al.: Gastrointestinal stromal tumors in children and young adults: a clinicopathologic, molecular, and genomic study of 15 cases and review of the literature. J Pediatr Hematol Oncol 2005, 27:179–187.

    Article  PubMed  Google Scholar 

  17. Janeway KA, Liegl B, Harlow A, et al.: Pediatric KIT wild-type and platelet-derived growth factor receptor alpha-wild-type gastrointestinal stromal tumors share KIT activation but not mechanisms of genetic progression with adult gastrointestinal stromal tumors. Cancer Res 2007, 67:9084–9088.

    Article  PubMed  CAS  Google Scholar 

  18. Agaram NP, Laquaglia MP, Ustun B, et al.: Molecular characterization of pediatric gastrointestinal stromal tumors. Clin Cancer Res 2008, 14:3204–3215.

    Article  PubMed  CAS  Google Scholar 

  19. Orosz Z, Tornoczky T, Sapi Z: Gastrointestinal stromal tumors: a clinicopathologic and immunohistochemical study of 136 cases. Pathol Oncol Res 2005, 11:11–21.

    Article  PubMed  Google Scholar 

  20. Rauf F, Bhurgri Y, Pervez S: Gastrointestinal stromal tumors: a demographic, morphologic and immunohistochemical study. Indian J Gastroenterol 2007, 26:214–216.

    PubMed  CAS  Google Scholar 

  21. Koay MH, Goh YW, Iacopetta B, et al.: Gastrointestinal stromal tumours (GISTs): a clinicopathological and molecular study of 66 cases. Pathology 2005, 37:22–31.

    Article  PubMed  Google Scholar 

  22. Corless CL, Fletcher JA, Heinrich MC: Biology of gastrointestinal stromal tumors. J Clin Oncol 2004, 22:3813–3825.

    Article  PubMed  CAS  Google Scholar 

  23. Cypriano MS, Jenkins JJ, Pappo AS, et al.: Pediatric gastrointestinal stromal tumors and leiomyosarcoma. Cancer 2004, 101:39–50.

    Article  PubMed  Google Scholar 

  24. Sauseng W, Benesch M, Lackner H, et al.: Clinical, radiological, and pathological findings in four children with gastrointestinal stromal tumors of the stomach. Pediatr Hematol Oncol 2007, 24:209–219.

    Article  PubMed  Google Scholar 

  25. Price VE, Zielenska M, Chilton-MacNeill S, et al.: Clinical and molecular characteristics of pediatric gastrointestinal stromal tumors (GISTs). Pediatr Blood Cancer 2005, 45:20–24.

    Article  PubMed  Google Scholar 

  26. Liegl B, Hornick JL, Corless CL, Fletcher CD: Monoclonal antibody DOG1.1 shows higher sensitivity than KIT in the diagnosis of gastrointestinal stromal tumors, including unusual subtypes. Am J Surg Pathol 2009, 33:437–446.

    Article  PubMed  Google Scholar 

  27. Kuroiwa M, Hiwatari M, Hirato J, et al.: Advanced-stage gastrointestinal stromal tumor treated with imatinib in a 12-year-old girl with a unique mutation of PDGFRA. J Pediatr Surg 2005, 40:1798–1801.

    Article  PubMed  Google Scholar 

  28. O’sullivan MJ, McCabe A, Gillett P, et al.: Multiple gastric stromal tumors in a child without syndromic association lacks common KIT or PDGFRalpha mutations. Pediatr Dev Pathol 2005, 8:685–689.

    Article  PubMed  Google Scholar 

  29. Li P, Wei J, West AB, et al.: Epithelioid gastrointestinal stromal tumor of the stomach with liver metastases in a 12-year-old girl: aspiration cytology and molecular study. Pediatr Dev Pathol 2002, 5:386–394.

    Article  PubMed  Google Scholar 

  30. Muniyappa P, Kay M, Feinberg L, et al.: The endoscopic appearance of a gastrointestinal stromal tumor in a pediatric patient. J Pediatr Surg 2007, 42:1302–1305.

    Article  PubMed  Google Scholar 

  31. Kerr JZ, Hicks MJ, Nuchtern JG, et al.: Gastrointestinal autonomic nerve tumors in the pediatric population: a report of four cases and a review of the literature. Cancer 1999, 85:220–230.

    Article  PubMed  CAS  Google Scholar 

  32. Andersson J, Sihto H, Meis-Kindblom JM, et al.: NF1-associated gastrointestinal stromal tumors have unique clinical, phenotypic, and genotypic characteristics. Am J Surg Pathol 2005, 29:1170–1176.

    Article  PubMed  Google Scholar 

  33. Delemarre L, Aronson D, van Rijn R, et al.: Respiratory symptoms in a boy revealing Carney triad. Pediatr Blood Cancer 2008, 50:399–401.

    Article  PubMed  Google Scholar 

  34. Carney JA, Sheps SG, Go VL, et al.: The triad of gastric leiomyosarcoma, functioning extra-adrenal paraganglioma and pulmonary chondroma. N Engl J Med 1977, 296:1517–1518.

    PubMed  CAS  Google Scholar 

  35. Carney JA: Gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma (Carney Triad): natural history, adrenocortical component, and possible familial occurrence. Mayo Clin Proc 1999, 74:543–552.

    Article  PubMed  CAS  Google Scholar 

  36. Horenstein MG, Hitchcock TA, Tucker JA: Dual CD117 expression in gastrointestinal stromal tumor (GIST) and paraganglioma of Carney triad: a case report. Int J Surg Pathol 2005, 13:87–92.

    Article  PubMed  Google Scholar 

  37. Tarn C, Rink L, Merkel E, et al.: Insulin-like growth factor 1 receptor is a potential therapeutic target for gastrointestinal stromal tumors. Proc Natl Acad Sci U S A 2008, 105:8387–8392.

    Article  PubMed  CAS  Google Scholar 

  38. Belinsky MG, Rink L, Cai KQ, et al.: The insulin-like growth factor system as a potential therapeutic target in gastrointestinal stromal tumors. Cell Cycle 2008, 7:2949–2955.

    PubMed  CAS  Google Scholar 

  39. Godwin AK, Rink L, Chi T, et al.: Insulin-like growth factor 1 receptor (IGF-1R): a potential therapeutic target for gastrointestinal stromal tumors (GIST) [abstract]. J Clin Oncol 2008, 26(May 20 Suppl):10507.

    Google Scholar 

  40. Bond M, Bernstein ML, Pappo A, et al.: A phase II study of imatinib mesylate in children with refractory or relapsed solid tumors: a Children’s Oncology Group study. Pediatr Blood Cancer 2008, 50:254–258.

    Article  PubMed  Google Scholar 

  41. Hayashi Y, Okazaki T, Yamataka A, et al.: Gastrointestinal stromal tumor in a child and review of the literature. Pediatr Surgery Int 2005, 21:914–917.

    Article  Google Scholar 

  42. Janeway KA, Matthews DC, Butrynski JE, et al.: Sunitinib treatment of pediatric metastatic GIST after failure of imatinib [abstract]. J Clin Oncol 2006, 24(18S Suppl):9519.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew K. Godwin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rink, L., Godwin, A.K. Clinical and molecular characteristics of gastrointestinal stromal tumors in the pediatric and young adult population. Curr Oncol Rep 11, 314–321 (2009). https://doi.org/10.1007/s11912-009-0044-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-009-0044-0

Keywords

Navigation