P1824 - Cases of Gastrointestinal Stromal Tumor (GIST) Associated With Liver Abscesses: A Systematic Review

MAHMOUD NASSAR, MD, PhD, MSc, MHA, MPA¹, Howard Chung, MD², Beishi Zheng, MD³, Mahmoud Awad, MD⁴, Bahaaeldin Baraka, MD, MRCP⁵, Mostafa Alfishawy, MD⁶, Hatem Elalfy, MD, PhD⁷, Ahmed H. Alhawarey, MD, PhD⁷, Mustafa Naemattalah, MD, Ph⁸, Negar Niknam, MD⁹, Mahmoud El-Bendary, MD^10
1Icahn School of Medicine at Mount Sinai / Queens, New York, NY; ²Queens Hospital Center, Forest Hills, NY; ³Woodhull Medical and Health Care Center, Brooklyn, NY; ⁴The Memorial Souad Kafafi University Hospital, Orland Park, IL; ⁵Broomfield Hospital, Mid and South Essex NHS Foundation Trust, Essex, England, United Kingdom; ⁶Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Al Qahirah, Egypt; ⁷Mansoura University, Mansoura, Ash Sharqiyah, Egypt; ⁸Mansoura University, Mansura, Ash Sharqiyah, Egypt; ⁹Icahn School of Medicine at Mount Sinai, Jamaica, NY; ¹⁰Mansoura Faculty of Medicine, Mansoura University, Mansoura, Ad Daqahliyah, Egypt

Introduction: Gastrointestinal stromal tumors (GISTs) are common subepithelial gastrointestinal (GI) tumors with different clinical presentations and are classified according to the risk of malignancy. Many case reports have documented the occurrence of liver abscesses in GIST, but the association with tumor pathology and presentation has not been documented. This systemic review aims to reveal the association of GIST as a cause or predisposing factor for liver abscesses.

Methods: All included studies were extracted from Embase and Medline. Inclusion criteria are case reports or case series that confirmed a gastrointestinal stromal tumor associated with liver abscesses. We excluded case reports of a gastrointestinal stromal tumor without a liver abscess. All literature reviews, guidelines, and review articles were excluded from this study. Studies that were published in languages other than English were not included. We screened 54 articles and included 26 articles.

Results: The patients had variable presentations from asymptomatic to sepsis. Tumors were found either in the stomach or in the small intestine, with or without abscess formation. Most GISTs were benign with a low mitotic index, and only two cases were malignant GISTs. In addition to the liver, abscesses can also be found in the tumor itself or in other parts of the GI tract. Eleven cases showed positive culture results from abscess drainage. Blood cultures and/or abscess cultures showed different types of certain streptococcus: S. Viridans, S. anginosus, S. Milleri, S intermedius, and S. constellatus. Ten cases showed multiple liver abscesses similar to metastasis from malignancies, and only seven cases had a single liver abscess. One case was malignant GIST.

Abscesses were also found in the right and left lobes of the liver, but more often in the right lobe of the liver. This may be due to the relatively larger size of the right lobe. All cases are confirmed by positive CD117. The DOG1 gene was tested positive in 2 cases. All patients received broad-spectrum intravenous antibiotics with or without tumor resection.

Discussion: Liver abscesses with GIST are not uncommon. They are usually associated with hematogenous seeding in bacteremic patients, with the Streptococcus anginosus group being the predominant pathogen. Although infections may have a worse prognosis in patients with GI tumors, liver abscesses generally have a favorable outcome in GIST.


Figure: Figure 1: Shows a PRISMA flow chart of our literature search

Reference first author	year	age	sex	Site of GIST	Size of GIST	Immune test	Mitotic index	surgery	Imatinib	prognosis
Kim	2007	67	F	ileus	NA	NA	NA	NA	NA	NA
Hasegawa	2007	NA	NA	NA	NA	NA	NA	NA	NA	NA
Kumar	2008	44	M	Greater curvature	6.5x3.9cm	+ cKIT, CD34	NA	Y	N	NA
Kwona	2009	42	F	Retroperitoneum, posterior to duodenum	3.5cm	+cKIT, - CD34 focal + for smooth muscle actin,	NA	Y	N	NA
Pankaj Jain	2009	50	M	Stomach fundus	5cm	+CD117, desmin, CD34, focal + S100, smooth muscle actin	NA	N	Y	NA
Kurtz	2010	65	M	Stomach posterior wall	13x11x10cm	+CD117	NA	N	Y	NA
Kitagawa	2010	66	F	Jejunum	6cm	+cKIT, -CD34, -S100, -desmin, -smooth muscle actin	< 5/50	Y	N	NA
Kumar	2010	65	M	Fundus and greater curvature of stomach	4x3cm	+cKIT, CD34, Desmin, S100	5/50	NA	NA	NA
Castillo	2010	64	F	Duodenum	8x6cm	NA	NA	NA	NA	NA
Su	2010	58	F	NA	NA	NA	NA	NA	NA	NA
Satoshi Ogura	2011	50	F	Small intestine	NA	+cKIT, CD34	NA	N	Y	No recurrence
Marquez Rojas	2011	NA	NA	NA	NA	NA	NA	NA	NA	NA
Chang	2013	31	M	Distal Jejunum	3x3.5cm	+CD117	0-1/10	Y	N	No recurrence
Fakhrejahani	2014	73	M	Lesser curvature	8x11cm	+cKIT, CD117, CD34, neg for desmin, S100, smooth muscle actin, cytokeratin	< 5/50	Y	Y	metastasis
Mike	2014	49	F	Small bowel	NA	NA	NA	Y	N	NA
Al-Khazraji	2015	73	M	Stomach fundus	10cm	+CD117, CD34, neg cytokeratin, CD45	NA	N	Y	3m showed improvement
Musaad	2015	NA	NA	NA	NA	NA	NA	NA	NA	NA
Bansal	2016	73	M	Stomach fundus	10cm	+CD117	NA	N	Y	No recurrence
Benou	2016	52	M	Posterior wall of stomach	7x4x4cm	+CD117, DOG-1	< 5/50	Y	Y	No recurrence
Rodrigues	2016	70	F	Ileum	6.5x5x4cm	+CD117, neg CD34, S100	1-2/50	Y	Y	No recurrence
Gorelik	2018	63	F	Pelvis	9cm	+CD117, CD34, neg S100	< 5/50	Y	Y	No recurrence
Kawai	2018	69	M	Stomach	NA	NA	NA	Y	N	NA
Conte	2020	66	M	Ileum	4x5.7cm	+CD117, vimentin, SMA, ERG, beta-catenin, neg calretinin, CAM 5.2, desmin, S100, SOX10, Ki67	< 5/50	Y	Y	No recurrence
Chung	2020	70	M	Stomach fundus	4x5cm	NA	NA	N	N	N
Sanchez-Luna	2020	NA	NA	NA	NA	NA	NA	NA	NA	NA

Table: Table 1. GIST characteristics of patients with both abscess and GIST


Disclosures:
MAHMOUD NASSAR indicated no relevant financial relationships.
Howard Chung indicated no relevant financial relationships.
Beishi Zheng indicated no relevant financial relationships.
Mahmoud Awad indicated no relevant financial relationships.
Bahaaeldin Baraka indicated no relevant financial relationships.
Mostafa Alfishawy indicated no relevant financial relationships.
Hatem Elalfy indicated no relevant financial relationships.
Ahmed Alhawarey indicated no relevant financial relationships.
Mustafa Naemattalah indicated no relevant financial relationships.
Negar Niknam indicated no relevant financial relationships.
Mahmoud El-Bendary indicated no relevant financial relationships.


MAHMOUD NASSAR, MD, PhD, MSc, MHA, MPA¹, Howard Chung, MD², Beishi Zheng, MD³, Mahmoud Awad, MD⁴, Bahaaeldin Baraka, MD, MRCP⁵, Mostafa Alfishawy, MD⁶, Hatem Elalfy, MD, PhD⁷, Ahmed H. Alhawarey, MD, PhD⁷, Mustafa Naemattalah, MD, Ph⁸, Negar Niknam, MD⁹, Mahmoud El-Bendary, MD¹⁰. P1824 - Cases of Gastrointestinal Stromal Tumor (GIST) Associated With Liver Abscesses: A Systematic Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.