• Barham M. M. Salih Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



Gastrointestinal stromal tumor, Extra gastrointestinal tumor, AFIPC risk stratification, TNM staging



Gastrointestinal stromal tumors (GISTs) are rare and heterogeneous tumors that occur throughout the GIT most commonly in the stomach or small intestine. They grow from specialized cells in the gastrointestinal tract called interstitial cells of Cajal (ICCs) or precursors to these cells.


To describe GISTs cases and perform risk stratification based on both the (AFIP) classification and TNM staging.

Materials and Methods

The data were collected retrospectively from registries and documents in Hiwa Hospital and the histopathology department in Shorsh Teaching Hospital in Sulaimaniyah between 2010 and 2019. The histopathological features extracted from the reports included the site of a tumor, size of tumor, histological type, mitotic count/50 high power fields (HPF), risk behavior assessment, and presence or absence of necrosis, and metastasis. Risk stratification was conducted by assigning the cases to specific risk categories and groups for disease progression based on Armed Forces Institute of Pathology Criteria (AFIPC) and staging according to the TNM system (AJCC 8th edition).


A total of 109 cases of GIST diagnosed between 2010 and 2019 were included. More than half (52.3%) of the cases were female. The age range was 28 to 87 years with a mean age of 58 years. Most (67.9%) of GISTs occurred between 48 and 77 years of age. The mean diameter of tumors was 8.18 cm. Around half (48.6%) of the GISTs were in the stomach, 60.6% of the cases had spindle cell type morphology and 82.6% were CD117 positive. Based on AFIPC risk stratification 34.0 % of the total cases were high risk. As per the Staging criteria of the TNM system (AJCC 8th edition), 37.6% were stage I followed by stage III (28.4%), stage II (17.4%), and stage IV (16.5%). 


Most of the patients in the current study had GIST in the stomach and were in a high-risk category. The current epidemiological and morphologic findings were similar to prevailing knowledge. However, only 82.6% were CD 117 Positive.


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