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Gastrointestinal Stromal Tumors in Children and Young Adults: A Clinicopathologic, Molecular, and Genomic Study of 15 Cases and Review of the Literature

Prakash, Sonam MD*; Sarran, Lisa MS*; Socci, Nicholas PhD; DeMatteo, Ronald P MD; Eisenstat, Jonathan MD§; Greco, Alba M MD§; Maki, Robert G MD, PhD; Wexler, Leonard H MD; LaQuaglia, Michael P MD; Besmer, Peter PhD#; Antonescu, Cristina R MD*#

Journal of Pediatric Hematology/Oncology: April 2005 - Volume 27 - Issue 4 - p 179-187
doi: 10.1097/01.mph.0000157790.81329.47
Original Article

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the intestinal tract that typically occur in adults over the age of 40 years. GISTs in younger patients are rare and not well characterized. The objective was to define the characteristics of GISTs in children and young adults (<30 years old). Clinicopathologic and molecular features, including KIT/PDGFRA genotype, in GISTs from 5 children and 10 young adults were analyzed. Gene expression analysis was performed on 5 gastric tumor samples from 2 children, 2 gastric tumors from young adults, and 10 gastric GISTs from older adults using an U133A Affymetrix platform (22,000 genes). All five pediatric GISTs occurred in girls, involved the stomach as multiple nodules, showed predominantly an epithelioid morphology, often involved lymph nodes, and lacked KIT or PDGFRA mutations. Although all five patients developed recurrence (four in the liver, three in the peritoneum, and two in both sites), four are still alive with disease. Of the 10 GISTs in young adults, half occurred in the small bowel and had spindle cell morphology, and one case had lymph node metastasis. KIT mutations were identified in seven cases, four in exon 11 and three in exon 9. Seven patients developed recurrence, and at last follow-up two patients had died of disease. Gene expression analysis showed high expression of PHKA1, FZD2, NLGN4, IGF1R, and ANK3 in the pediatric and young adult versus older adult cases. GISTs that occur in children are a separate clinicopathologic and molecular subset with predilection for girls, multifocal gastric tumors, and wild-type KIT/PDGFRA genotype. In contrast, GISTs in young adults are a more heterogeneous group, including cases that resemble either the pediatric or the older adult-type tumors. The distinct gene expression profile suggests avenues for investigation of pathogenesis and potential therapeutic strategies.

From the *Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York; †Department of Computational Biology, Sloan-Kettering Institute, New York, New York; ‡Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; §Department of Pathology, New York University, New York, New York; ¶Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; ∥Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York; and #Department of Developmental Biology, Sloan-Kettering Institute, New York, New York.

Received for publication June 26, 2004; accepted January 21, 2005.

Supported in part by ACS MRSG CCE-106841 (C.R.A.), PO1 CA 47179-10A1 (C.R.A.), American College of Surgeons Oncology Group (R.P.D.), NCI CA94503 (R.P.D.), NCI CA102774 (P.B.), and NIH HL/DK55748 (P.B.).

Reprints: Cristina R. Antonescu, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.