Cameron Current Surgical Therapy 11th Edition Free Extra Quality Download
Due to their resemblance under light microscopy, GISTs were not regarded as a distinct pathological entity in earlier literature but as smooth muscle neoplasms and most were designated as leiomyomas, leiomyoblastomas, leiomyosarcomas, or schwannomas. GISTs are now thought to ascend from the interstitial cells of Cajal or their stem cell precursors, which are normally part of the autonomic nervous system of the gastrointestinal tract and operate as a pacemaker in controlling GI motility [22, 23]. This finding was followed by the development of therapeutic agents that suppress tumor growth by specifically inhibiting this signal (imatinib mesylate, sunitinib malate) [1, 24]. Complete surgical resection with no tumor rupture remains the gold standard of treatment along with adjuvant TKI therapy, typically consisting of imatinib mesylate . Our patient had initially received imatinib which had to be discontinued due to significant side effects. Between 15% and 50% of patients with GIST have already metastatic disease at diagnosis. Common sites of metastasis include the liver, peritoneum, and omentum ; metastases to lymph nodes and extra-abdominal structures (lung, bone, soft tissue, and brain) are uncommon (
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In conclusion, even though skeletal muscle metastases from GISTs are rare, the likelihood of identifying metastases in unusual sites is increasing due to major improvement in the progression-free survival and overall survival rates of patients with GISTs. Additionally, side effects from TKIs are common, and therefore skeletal muscle metastases should likely be totally surgically excised.
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