Regardless of the rarity in incidence and prevalence gastrointestinal stromal tumor (GIST) has emerged as a distinct pathogenetic entity. (KGSG) published the first guideline for optimal diagnosis and treatment of GIST in Korea. As the second version of the guideline we herein have updated recent clinical recommendations and reflected changes in diagnosis surgical and medical treatments for more optimal clinical practice for GIST in Korea. We hope the guideline can be of help in enhancing the quality of diagnosis by members of the Korean associate of physicians including in GIST patients’s care and subsequently in achieving optimal efficacy of KN-62 treatment. and contain an oncogenic mutation in the (80-85%) or platelet-derived growth factor receptor (or can have implications for prognosis and management in patients with advanced disease mutation analysis should be considered at the time of diagnosis. Mutational analysis for exons 9 11 13 and 17 or exons 12 14 and 18 can be performed with unstained slides from formalin-fixed paraffin-embedded tissue or fresh frozen tissue. SURGICAL TREATMENT OF GIST Surgical treatment as first-line therapy The main treatment of resectable localized GIST is usually surgery. The target is comprehensive resection without residual tumor cells (R0). Medical diagnosis The initial medical diagnosis is generally created by endoscopy endoscopic ultrasound gastrography or computed tomography (CT) from the tummy due to problems with obtaining sufficient tissues. It ought to be verified by pathologic histological results after resection. Preoperative histological medical diagnosis is feasible nonetheless it may be tough to interpret definitively (21-24). Imaging lab tests to identify metastasis include upper body radiography (or chest CT) triphasic CT of the belly and pelvis and/or magnetic resonance imaging (MRI) if necessary (25). Positron emission tomography (PET) may be performed when evidence of metastasis may be equivocal or for medical tests (21). Biopsy There is no consensus regarding the need of endoscopic ultrasound biopsy or percutaneous biopsy for preoperative analysis. The important portion of histological analysis is not to cause tumor Mouse monoclonal to EGF seeding during biopsy. Consequently unless multiple metastases are present excisional biopsy with laparotomy is definitely suggested (21 26 If analysis is unknown at the time of resection post-operative freezing tissue examination must be performed in order to elucidate the treatment strategy for GIST as treatment varies for an adenocarcinoma or lymphoma. Biopsy is necessary when planning neoadjuvant therapy. Indications for surgery Due to the high potential for malignancy of GIST resection should be the first-line treatment (21 27 We strongly recommend resection for tumors larger than 2 cm or growing tumors (21). Smaller KN-62 tumors (<2 cm) confer a lower potential for malignancy and may be observed. However small tumor size does KN-62 not exclude the potential for malignant transformation. Consequently individuals should be educated about the possibility of malignancy. Surgical margins The main objectives of surgical treatment are to acquire negative margins and to resect without causing tumor rupture. In case of inadvertent tumor infiltration into the surrounding organs a complete en bloc resection with bad margins should be performed (21 26 27 no matter size. Therefore actually tumors are small endoscopic shell-out process or enucleation should be avoided if GIST is definitely suspected. In many cases wedge resection of gastric GIST and segmental resection of small bowel GIST are appropriate treatments. Subtotal or total gastrectomy could be performed predicated on location and size. We recommend en bloc resection for mesenteric or omental GIST. Adjacent organs adherent to tumor also needs to be totally resected en bloc in order to avoid tumor rupture or intraabdominal seeding (26). Laparoscopic resection Laparoscopic resection is normally feasible if intraabdominal tumor seeding or rupture KN-62 is normally improbable. KN-62 KN-62 Laparoscopic resection should stick to concepts of oncologic medical procedures. Generally it really is reserved for little favorably located gastric GISTs (28-31). Intra-operative laparoscopic or endoscopy ultrasound enable you to help out with laparoscopic resection if needed. Lymphadenectomy Unlike adenocarcinoma GIST metastasizes to neighborhood regional lymph nodes seldom. Lymphadenectomy is Therefore.