Cost-Effectiveness Analysis of Tyrosine Kinase Inhibitors in Gastrointestinal Stromal Tumor: A Systematic Review

Background: The introduction of tyrosine kinase inhibitor (TKI) therapy has dramatically improved the clinical effectiveness of patients with locally advanced and/or metastatic gastrointestinal stromal tumors (GIST), and this systematic review was conducted aiming at the cost-effectiveness analysis of TKIs in GIST.Methods: A thorough literature search of online databases was performed, using appropriate terms such as “gastrointestinal stromal tumor or GIST,” “cost-effectiveness,” and “economic evaluation.” Data extraction was conducted independently by two authors, and completeness of reporting and quality of the evaluation were assessed. The systematic review was conducted following the PRISMA statement.Results: Published between 2005 and 2020, 15 articles were incorporated into the systematic review. For advanced GIST, imatinib followed by sunitinib was considered cost-effective, and regorafenib was cost-effective compared with imatinib re-challenge therapy in the third-line treatment. For resectable GIST, 3-year adjuvant imatinib therapy represented a cost-effective treatment option. The precision medicine-assisted imatinib treatment was cost-effective compared with empirical treatment.Conclusion: Although identified studies varied in predicted costs and quality-adjusted life years, there was general agreement in study conclusions. More cost-effectiveness analysis should be conducted regarding more TKIs that have been approved for the treatment of GIST.Systematic Review Registration:https://www.crd.york.ac.uk/, PROSPERO: CRD42021225253.

Combined laparoscopic-endoscopic “rendez-vous” procedure in a case of gastric Schwannoma in a toddler

Introduction. Schwannomas are rare benign tumors of the gastrointestinal tract. Despite the differences in features of schwannomas located in the stomach as opposed to peripheral or soft tissue schwannomas, their immunohistochemical characteristics are the same. We present a case of a 14-month-old boy with a gastric tumor who underwent a combined laparoscopic-endoscopic resection surgery, followed by gastric schwannoma diagnosis. Case outline. The patient was admitted to our pediatric hospital with a fever of unknown origin. Endoscopy, performed after recurrent hematemesis, revealed an ulcer in the gastric antrum. At the four-week follow-up, gastroscopic and microscopic findings were normal. Two weeks later, a flank mass in the antrum was detected by an ultrasound examination. A new gastroscopy and CT scan confirmed the presence of a tumor-like mass, 5 cm in diameter. A combined laparoscopic-endoscopic polypectomy was performed with a necessary conversion for complete resection of tumor. The initial histological findings were consistent with a gastrointestinal stromal tumor. Due to this tumor?s rarity in childhood, the paraffin-embedded tissue samples were referred for a second opinion. Histological and immunohistochemical characteristics of the tumor made the gastrointestinal stromal tumor diagnosis unlikely and consistent with a completely resected gastric schwannoma. No recurrence of the disease occurred during the seven-year follow-up. Conclusion. Combined laparoscopic-endoscopic surgery is a feasible and effective treatment for large gastric tumors that cannot be excised endoscopically. Schwannoma should be included in the differential diagnostic consideration of gastric tumor lesions even in childhood.

Extragenital endometrial stromal sarcoma of transverse mesocolon: A diagnostic conundrum

Endometrial stromal sarcoma (ESS) is a rare uterine neoplasm infrequently arising in extra-genital sites. Herein, we report an extremely rare case of primary extra-genital ESS of transverse mesocolon occurring in a 51-year-old female presenting with gradually increasing abdominal mass. The clinical diagnosis considered was a gastrointestinal stromal tumor. Intra-operatively, the mass was confined exclusively to the transverse mesocolon. Microscopy revealed a cellular tumor composed of oval to elongate neoplastic cells with hyperchromatic nuclei, inconspicuous nucleoli and were immunoreactive for CD10, progesterone receptor (PR), estrogen receptor (ER), and PAX8; negative for KIT, CD34, SMA, S100, synaptophysin, chromogranin, WT-1, and calretinin. A distinct arborizing network of arterioles along with foci of endometriosis was also seen. We present this case for its extreme rarity and the challenges entailed in its diagnosis.