Open Access Medical Books



Edited by Raimundas Lunevicius.

130 pages .
Open Access .

One year ago I was kindly asked by Ms Ana Pantar and Mr Bojan Rafaj, editorial consultants at InTech (, leading Open Access publisher of scientific books and journals in the science, technology, and medicine fields; to edit the book that would provide comprehensive knowledge on a group of malignant mesenchymal tumours named gastrointestinal stromal tumours (GISTs). I was also asked to write the preface for this book, to which I am delighted to do for both parts. The invitation itself brought up a few questions. What should the style and structure of the book be?
Should it be in a form of a textbook or handbook, whereby the titles of chapters reflect a fundamental structure and the content of the educational book (historical overview, epidemiology, genetics, pathology, classifications, clinical presentation, diagnosis, etc.) or should it be a collection of selected comprehensive review articles, reports of original studies, and case presentations, contributed by clinical oncologists, surgeons, pathologists, and researchers from various institutions of Europe, Asia, and the US?
The power of reality was stronger than the power of imagination. We ended up with the kind of book which can be characterized as a collection of review papers mainly on diagnostics and management of GISTs, and a few golden pieces of original research. In this context I think that the fact that 31 authors of the papers, work in different countries and institutions, thus amplified value of their shared reviews, opinions, and unique clinical and pathological experience. A reader of the book, therefore, will be able to find essential knowledge and key facts about gastrointestinal stromal tumours’ epidemiology, genetics, molecular biology, etiology, mechanisms of tumor development, pathology, diagnostics, classifications, surgical and conservative management, and prognosis as the book reflects a theory and practise on GISTs. That would mean that the aim of this project for me is – to help the reader to obtain an objective and comprehensive general picture of GISTs, as well as to present a useful and educational reference for physicians and surgeons, residents and medical students – to be achieved. One should be bear in mind before opening the first page of this book, that this special issue dedicated to GISTs lays no claim of encompassing the whole of the GIST problem per se in all its multidisciplinary fundamental complexity.
The sequence of the chapters has been chosen in order to highlight areas of current practise, change in management, variability of features of GISTs, and original research.
The review “GISTs: from the history to the tailored therapy” provided by Roberta Zappacosta and co-workers (Italy) demonstrates how the GIST, went from being poorly defined, to a treatment-resistant neoplasia which became a well recognised, well understood and effectively treated neoplasia. The second paper “Treatment Options for Gastrointestinal Stromal Tumors” written by Kai-Hsi Hsu (Taiwan, Republic of China) was dedicated to the management of GIST with respect to tumour location and disease stage. It emphasises a multidisciplinary team approach in managing patients with GIST. The author expresses a reasonable assumption that future treatment of GIST may move towards individualised targeted therapy in combination with surgery in order to optimise clinical outcomes. The “Molecularly targeted therapy: imatinib and beyond” (Andrew Poklepovic and Prithviraj Bose, USA) was focused on the molecular biology of gastrointestinal stromal tumours with emphasis on therapy; targeting the primary activating mutations in the KIT proto-oncogene. The studies that have led to the approval of current adjuvant and neo-adjuvant therapy were effectively reviewed in this paper. The significance of basic research towards a deeper understanding of the primary and secondary mutations of proto-oncogenes is timely pointed out. António M. Gouveia and José Manuel Lopes (Portugal) discuss different aspects of surgical treatment of GISTs. They emphasise that complete surgical resection without lymph node dissection is considered to be a standard treatment for primary localised non-metastatic gastrointestinal stromal tumours, and nowadays, is the only potential curative current treatment for patients. The overview “The role of the surgeon in multidisciplinary approach to gastrointestinal stromal tumours” (written by Selim Sözen and co-workers, Turkey) draws limits and shows significance of surgical management of gastrointestinal stromal tumours. Aiwen Wu (PR China) explores the most important aspects of GIST in the anorectum. Mainly, this report includes diagnosis, differential diagnosis, and treatment of anorectal GIST. An interesting and uncommon case of extragastrointestinal stromal tumour located in the rectovaginal septum was described by Josefa Marcos Sanmartín and co-workers (Spain). This excellent case report with literature review demonstrates necessity and the importance of considering ‘extragastrointestinal stromal tumours’ in the differential diagnosis of mesenchymal neoplasms in the vulvovaginal-rectovaginal septum. The paper written by Ardeleanu Carmen Maria and Enache Simona (Romania) explores variability of the histopathological, immunohistochemical and molecular features of gastrointestinal stromal tumours. Again, it shows that the idea to profile an individual patient‘s GIST mutations is of paramount importance for targeted therapy. Keishiro Aoyagi, Kikuo Kouhuji, and Kazuo Shirouzu (Japan) presented results of original clinicopathological and immunohistochemical study. They assessed the reliabilities of the Ki-67 labeling index, the expression of c-kit, p53, and bcl-2, and the apoptotic count for predicting potential malignancy of gastrointestinal stromal tumour. Finally, a meta-analysis

aimed to derive a more precise estimation of the relationship between p53 and biologic behaviour of gastrointestinal stromal tumour was performed by Zong Liang, and Chen Ping. Evidence from 19 studies including 1163 patients, was gained and discussed in a highly conclusive manner. In short, despite the fact that there have been some manuscripts on GISTs in the past; I am pleased to see this book on gastrointestinal stromal tumours. I salute the authors for their professional dedication and outstanding work in summarizing their clinical and research practices with established and upcoming theories on GISTs, as this always helps to implement better management procedures to a given standard.

Raimundas Lunevicius MD, PhD, Dr Sc, FRCS
1King’s College Hospital NHS Foundation Trust, London,
2Professor of General Surgery, Vilnius University,
1United Kingdom



 1 GISTs: From the History to the Tailored Therapy 1 Roberta Zappacosta, Barbara Zappacosta, Serena Capanna, Chiara D’Angelo, Daniela Gatta and Sandra Rosini

 2 Treatment Options for Gastrointestinal Stromal Tumors 29 Kai-Hsi Hsu

 3 Molecularly Targeted Therapy: Imatinib and Beyond 47 Andrew Poklepovic and Prithviraj Bose

 4 Surgical Treatment of Gastrointestinal Stromal Tumors (GISTs) 61 António M. Gouveia and José Manuel Lopes

 5 The Role of the Surgeon in Multidisciplinary Approach to Gastrointestinal Stromal Tumors 75 Selim Sözen, Ömer Topuz and Yasemin Benderli Cihan

 6 Gastrointestinal Stromal Tumor of the Rectovaginal Septum, a Diagnosis Challenge 91 Josefa Marcos Sanmartín, María José Román Sánchez, José Antonio López Fernández, Óscar Piñero Sánchez, Amparo Candela Hidalgo, Hortensia Ballester Galiana, Natalia Esteve Fuster, Aránzazu Saco López and Juan Carlos Martínez Escoriza

 7 The Significance of the Ki-67 Labeling Index, the Expression of c-kit, p53, and bcl-2, and the Apoptotic Count on the Prognosis of Gastrointestinal Stromal Tumor 107 Keishiro Aoyagi, Kikuo Kouhuji and Kazuo Shirouzu

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Published by: Unknown - Thursday, March 28, 2013


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