Incidental Findings of Gastrointestinal Stromal Tumors (GIST) in Gynecological Surgery

Backgound: GISTs originate from Cajal cells or their precursors in the gastrointestinal tract (Kim & Lee 2024). These rare tumors encounter for about 1% of all gastrointestinal tumors and can develop anywhere in the GI system (Hitscherich et al. 2021, Gootee et al. 2025). Clinical symptoms are often non-specific, including abdominal discomfort, increased abdominal girth, and gastrointestinal disturbances, with up to 30% diagnosed incidentally (Hitscherich et al. 2021, Gootee et al. 2025, Tonni et al. 2024). Preoperative misdiagnosis as gynecological tumors can significantly impact treatment and prognosis (Boyle et al. 2022, Tonni et al. 2024).

Methods: Between 2013 and 2025, 5 patients with GISTs were incidentically diagnosed during gynecolgic surgery performed because of abdominal mass lesions, mimicking gynecologic tumors. Clinico-pathologic data were analysed. All tumors underwent immunohistochemical (CD117, DOG1, CD34, ER, PR, p53, Desmin, SMA) and molecular profiling (KIT, PDGFRA).

Results: The median age of the women was 67 years. GISTs presented as large masses in the lower pelvis,measuring 75 to 150 mm (mean size 106 mm). Two of the four cases underwent biopsy, revealing predominantly spindle cell morphology with a mitotic count of fewer than 5 per 50 high-power fields (HPF); one case had a count of 15 per 50 HPF. Immunohistochemical analysis indicated moderate to strong reactivity to CD117 and DOG1. Molecular testing on three cases identified c-KIT mutations in exon 11.

Conclusion: GISTs are typically diagnosed in individuals over 40 (Kim & Lee 2024), consistent with the median age of 67 observed in the present study. GISTs may be seen incidentally e.g. during bariatric and gynecologic surgery (Hitscherich et al. 2021, Gootee et al. 2025, Tonni et al. 2024). Incidentally diagnosed GIST represent 25% of all GISTs (Hitscherich et al. 2021) and diagnosis during gynecologic surgery represent the lowest freqency. Clinicopathologic features of incident gyn-GISTs are similar to other incidentally tumors.

Publikationsverlauf

Artikel online veröffentlicht:
11. Juni 2025