Stomach
General
Staging-GIST
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Staging gastrointestinal stromal tumor [title]
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Cite this page: Gonzalez RS. Staging-GIST. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachgiststaging.html. Accessed June 8th, 2023.
Pathologic TNM staging of gastrointestinal stromal tumors, AJCC 8th edition
Definition / general
- Sporadic nonpediatric gastrointestinal stromal tumors (GISTs) of any gastrointestinal organ are covered by this staging system
- Pediatric, familial and syndromic GISTs are not staged using AJCC criteria
ICD coding
- C49.A0: Gastrointestinal stromal tumor, unspecified site
Primary tumor (pT)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- T1: Tumor ≤ 2 cm
- T2: Tumor > 2 cm but ≤ 5 cm
- T3: Tumor > 5 cm but ≤ 10 cm
- T4: Tumor > 10 cm
Regional lymph nodes (pN)
- N0: No regional lymph node metastasis or unknown lymph node status
- N1: Regional lymph node metastasis
Notes:
- Nodal metastasis is very rare in sporadic nonpediatric GISTs
- Regional lymph nodes vary depending on site of origin
Mitotic rate
- Low: 5 or fewer mitoses per 5 mm2
- High: More than 5 mitoses per 5 mm2
Prefixes
- y: Preoperative radiotherapy or chemotherapy
- r: Recurrent tumor stage
Stage grouping
Gastric and omental GIST
Stage IA: | T1 - 2 | N0 | M0 | Low mitotic rate
|
Stage IB: | T3 | N0 | M0 | Low mitotic rate
|
Stage II: | T1 - 2 | N0 | M0 | High mitotic rate
|
| T4 | N0 | M0 | Low mitotic rate
|
Stage IIIA: | T3 | N0 | M0 | High mitotic rate
|
Stage IIIB: | T4 | N0 | M0 | High mitotic rate
|
Stage IVA: | Any T | N1 | M0 | Any mitotic rate
|
| Any T | Any N | M1 | Any mitotic rate
|
Esophageal, small intestinal, colorectal, mesenteric and peritoneal GIST
Stage I: | T1 - 2 | N0 | M0 | Low mitotic rate
|
Stage II: | T3 | N0 | M0 | Low mitotic rate
|
Stage IIIA: | T4 | N0 | M0 | Low mitotic rate
|
| T1 | N0 | M0 | High mitotic rate
|
Stage IIIB: | T2 - 4 | N0 | M0 | High mitotic rate
|
Stage IVA: | Any T | N1 | M0 | Any mitotic rate
|
| Any T | Any N | M1 | Any mitotic rate
|
Registry data collection variables
- Tumor size
- Tumor site (esophagus, stomach, duodenum, jejunum / ileum, rectum, extraintestinal)
- Tumor mitotic rate
- Tumor rupture
- Tumor metastasis (liver, peritoneum, other)
- Tumor KIT immunohistochemistry
- Tumor mutational status of KIT and PDGFRA (if known)
Histologic grade
- Same as mitotic rate (see above)
Histopathologic type
- Spindle cell, epithelioid and mixed cell types
Survival data
Gastric GISTs
Stage | Tumor size (cm) | Mitotic rate | Observed rate of progressive disease
|
Stage IA: | ≤ 5 | Low | 0 - 2%
|
Stage IB: | > 5 - 10 | Low | 3 - 4%
|
Stage II: | ≤ 2 | High | Insufficient data
|
| > 2 - 5 | High | 16%
|
| > 10 | Low | 12%
|
Stage IIIA: | > 5 - 10 | High | 55%
|
Stage IIIB: | > 10 | High | 86%
|
Small intestinal GISTs
Stage | Tumor size (cm) | Mitotic rate | Observed rate of progressive disease
|
Stage IA: | ≤ 5 | Low | 0 - 4%
|
Stage II: | > 5 - 10 | Low | 24%
|
Stage IIIA: | ≥ 10 | Low | 52%
|
| ≤ 2 | High | 50%
|
Stage IIIB: | > 2 - 5 | High | 73%
|
| > 5 - 10 | High | 85%
|
| > 10 | High | 90%
|
Board review style question #1
Using AJCC 8th edition criteria, which of the following neoplasms may be staged as pN0 even if no lymph nodes are received for pathologic examination?
- Appendiceal goblet cell carcinoid
- Gastric neuroendocrine carcinoma
- Gastrointestinal stromal tumor
- Rectal adenocarcinoma with neoadjuvant treatment
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