Introducere: Tumorile gastrointestinale stromale (TGIS) reprezintă 0,1—3% din malignitatile mezenchimale ale tractului gastro-intestinal. Stomacul este cel mai frecvent afectat organ, iar tumorile gigante se întâlnesc rar. Obiectiv: Analiza particularităţilor clinice, aspectelor histopatologice, imunohistochimice şi rezultatelor tratamentului TGIS gastrice gigante. Material şi metode: Studiul retrospectiv al bazei de date a 73 de pacienţi cu tumori GIST (c-kit(CD117)(+) operaţi între 2007-2015. Rezultate: Lotul de cercetare –7 pacienţi cu TGIS gastrice gigante, raportul bărbaţi:femei–1.3:1, vârsta medie 59.0±1.6 (95% CI:55.08-62.92) ani. Diagnosticul preoperator de tumoră gastrică prin TC abdomenului – 100% cazuri. Gradul înalt al necrozei intratumorale exprimat la TC prin hipodensitate centrală – în 5 (71.4%) cazuri vs. 2 (28.6%) – grad redus (p<0.05). Volumul operaţiilor: excizia tumorii peretelui gastric – 1 (14.3%) caz, rezecţie gastrică limitată – 2 (28.6%), gastrectomie subtotala – 4 (57.1%). Dimensiunea maximă în medie a tumorilor 23.4±1.3 (95% CI: 20.19-26.67) cm, dimensiunea minimă – 16.4±1.9 (95% CI: 11.62-21.23) cm. Profilul imunohistochimic al tumorilor: CD117(c-kit)(+)–7(100%), CD34(+)–6(85.7%), desmina(+)–1(14.3%), vimentina(+)–6(85.7%), S-100(+)–1(14.3%), SMA(+)–4(57.1%), NSE–0. Numărul mediu al mitozelor – 29.0±10.3 (95%CI:3.70-54.29). Tumorile cu indice mitotic înalt(>5/50HPF) au predominat asupra tumorilor cu indice mitotic redus (<5/50HPF) – 5(71.4%) vs. 2(28.6%)(p<0.05). Metastaze la adresarea primară s-au depistat în 28.6% (n=2) cazuri. Progresarea bolii – în 71.4% (n=5) dintre pacienţi. Tratament combinat – chirurgical şi target terapie cu imatinib mesilat – 7(100%) pacienţi. Concluzii: TGIS gastrice gigante sunt rare. Pentru TC este caracteristic gradul înalt al necrozei intratumorale. Tratamentul chirurgical rămâne principală opţiune curativă. TGIS gigante sunt mai frecvent cu risc înalt de progresare. Target terapia conduce la stabilizarea bolii.

Introduction: Gastrointestinal stromal tumors (GIST) represent 0.1-3% of mesenchymal malignancies of the gastrointestinal tract. Stomach is the most commonly affected organ, and giant tumors are rare. Aim: analysis of clinicopathologic characteristics, histopathological and immunohistochemical features and treatment results of giant gastric GIST. Material and methods: retrospective study of the database of 73 patients with (c-kit(CD117)(+) GIST treated between 2007—2015. Results: The study group –7 patients with giant gastric GIST, M:F=1.3:1, mean age – 59.0±1.6(95% CI:55.08— 62.92) years. Preoperative diagnosis of gastric tumor determined by abdominal CT – in 100% cases. The high grade of intratumoral necrosis expressed at CT by central hypodense areas was registred more frequent than low grade – 5(71.4%) cases vs. 2(28.6%) cases (p<0.05). Surgical options: excision of gastric tumor – 1(14.3%) case, gastric wedge resection – 2(28.6%), partial gastrectomy – 4(57.1%). The mean maximum size of tumors – 23.4±1.3(95% CI: 20.19-26.67) cm, mean minimum size– 16.4±1.9(95% CI: 11.62-21.23) cm. Immunohistochemical phenotype: CD117(c-kit)(+)–7(100%), CD34(+)–6(85.7%), desmin(+)–1(14.3%), vimentin(+)–6(85.7%), S-100(+)–1(14.3%), SMA(+)–4(57.1%), NSE–0. Mean number of mitoses – 29.0±10.3(95%CI:3.70-54.29). Tumors with high mitotic count were registred more frequent than with low mitotic count – 5 (71.4%) vs. 2(28.6%) (p<0.05). Metastases at first presentation were recorded in 28.6% (n=2) cases. Disease progression was recorded in 71.4%(n=5) cases. Complex treatment – surgical and target therapy with imatinib mesylate – in 7(100%) patients. Conclusions: Giant gastric GISTs are rare. A high degree of intratumoral necrosis is characteristic at CT. Surgery remains the main treatment. High risk of progression is more common for giant GISTs. Target therapy induces stable disease.