Lymph node metastasis in gastrointestinal stromal tumours (GIST) occurs preferentially in young patients < or = 40 years: an overview based on our case material and the literature.

PURPOSE: Data on the clinicopathological and biological profiles of gastrointestinal stromal tumours (GISTs) at higher risk for nodal metastasis are lacking.
MATERIALS AND METHODS: We reviewed our own case material and the relevant English literature.
RESULTS: Regional node metastasis was detected in two of 210 GISTs in our case material (1%) corresponding to 6% of 33 patients with nodal dissection (mean, 11 nodes) and 25% of those < or = 40 years of age. The two patients had a mean age of 32 years, contrasting with a mean age of 65 years for the whole cohort. One of them had incomplete Carney triad with pulmonary chondromas. The literature disclosed a comparable frequency of lymphatic spread among paediatric patients and young adults (approximately 20%), irrespective of the features of the Carney triad. Although a wider age range was reported in isolated reports, a majority (66%) of patients with lymph node metastasis were women < or = 40 years with gastric epithelioid/mixed type ulcerated endoluminal GIST presenting with GI bleeding.
CONCLUSION: Contrasting GISTs in elderly patients, lymphatic spread represents a common route of initial spread in patients < or = 40 with gastric GISTs, suggesting the need for node sampling in this particular subset of GIST patients. The prognostic significance of nodal metastasis in GIST patients remains to be further clarified.