gastrointestinal stromal tumors : computed tomographic imaging, endoscopy, immunohisochemistry,ploidy and patient outcome

الملخص EN

Introduction : Vascular access (VA) complications are the main causes of morbidity and hospitalization in hemodialysis (HD) patients.

The most common complication of VA is dysfunction or failure due to stenosis or thrombosis.

Aim : This work aimed to assess the relationship between platelets activation and other factors in VA failure in HD patients.

Methods: Thirty HD patients were divided into 2 groups.

Group A comprised 15 patients with recurrent VA failure, Group B comprised 15 patients whose fistulae were normally functioning for > 5 years.

All cases were subjected to: -Full clinical assessment with s Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors in the gastrointestinal tract.

It was found that most GIST expressed c-Kit, (a receptor tyrosine kinase encoded by proto-oncogenes c-kit).

GIST are considered to originate from interstitial cell of Cajal (ICC) or their precursor cells, the pace maker for autonomous gastrointestinal movement.

Material and Methods: Thirty five cases of stromal tumors constitute the material of this study.

All the cases were subjected to clinical and endoscopic examinations, computerized tomographic study (CT), surgical removal, and pathologic study (microscopic, immunohistochemical examination as well as detection of flow cytometric DNA ploidy status).

Results : Thirty out of the 35 cases were proved to be GIST as they c-Kit and/or CD-34 positive.

Four cases were leiomyomas and one case was schwannoma.

From the 30 GISTs, 28 cases (93%) were positive for c-Kit, 22 (73%) were CD-34 positive and 4 (14%) were SMA positive.

The aneuploid tumors were statistically associated with high mitotic count, epithelioid type, haemorrhage, necrosis and mucosal invasion, however, tumor size and cellularity did not show this significant relationship.

So, this study suggests that aneuploidy represents the high risk groups of GIST.

Different clinicopathologic parameters were correlated with relapse free survival.

The large tumor size, high mitotic figures and aneuploidy are the most important parameters that predict recurrence and survival, while the cell type and cellularity are the least effective ones.

Computerized tomography (CT) has been shown to be an efficient diagnostic tool in the detection, characterization and follow up of GIST being capable of detecting both intraluminal and extraluminal growth, furthermore direct extension to adjacent organs, peritoneal and organ metastasis can be diagnosed as well.ecial stress on history of recurrent hypotensive attacks during dialysis (RHA), erythropoietin therapy and signs of VA failure.

- Laboratory investigations including: Complete blood cell count (CBC) and measurement of hematocrit value and erythrocyte sedimentation rate (ESR).

Kt / V, serum lipid profile, serum albumin, Pselectin and plasma fibrinogen levels was measured.

-Doppler ultrasound examination of VA to assess its patency and to measure VA blood flow rate was carried out.

Results : Group A had significantly higher number of RHA, lower Kt / V and higher serum triglycerides levels.

There was no significant statistical difference between the two groups as regards history of erythropoietin therapy, CBC, hematocrite value, ESR, total cholesterol, LDL-cholesterol and HDL-cholesterol.

Group A had significantly lower serum albumin levels, higher serum P-selectin levels, and higher plasma fibrinogen levels.

Serum albumin was directly correlated with the average duration of VA and inversely correlated with serum P-selection and plasma fibrinogen levels.

Serum P-selectin was inversely correlated with average duration of VA.

Doppler blood flow rate of VA was significantly lower in group A with venous stenosis in 5 patients, partial venous thrombosis in 5 patients and complete venous thrombosis in 2 patients.

Conclusion : We concluded that : RHA, Hypertriglyceridemia, hypo-albuminemia and hyper-fibrinogenemia play a role in