Tumor size (cm) | Risk of disease progression during long-term follow-up by primary site | |||
Gastric | Jejunum/ileum* | Duodenum | Rectum | |
Mitotic rate¶ (HPF): ≤5/50 | ||||
≤2 | No risk | No risk | No risk | No risk |
2 to 5 | Very low | Low | Low | Low |
5 to 10 | Low | Intermediate | Limited data | Limited data |
>10 | Intermediate | High | High | High |
Mitotic rate¶ (HPF): >5/50 | ||||
≤2 | No riskΔ | HighΔ | Limited data | High |
2 to 5 | Intermediate | High | High | High |
>5 | High | High | High◊ | High◊ |
AFIP: Armed Forces Institute of Pathology; HPF: high-power fields.
* Patients with other anatomic primary sites (esophagus, mesentery, peritoneum) or those with limited data follow the risk stratification of jejunum/ileum tumors.
¶ Mitotic rate is counted in an area of 5 square millimeters (mm2) on the glass slide section. For older microscopes with traditional field size optics, 50 HPF is equivalent to 5 mm2. For modern microscopes with wider 40× lenses/fields, 20 HPF is equivalent to 5 mm2. If necessary, the field of view should be measured to determine the actual number of HPF required to cover a 5 mm2 area.[1]
Δ Small number of cases.
◊ Data are combined for tumors >5 cm. There are limited data for duodenal and rectal tumors between 5 and 10 cm in size.Adapted from: Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006; 23:70.
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