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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 3: 63 year old male with an abdominal mass.
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Week 234: Case 3
63 year old male with an abdominal mass./images/8.9.05case31.jpg
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Answer: Gastrointestinal stromal tumor (GIST)
Histology: This is a malignant spindle cell lesion characterized by frequent mitoses and extensive areas of necrosis. The cells have a cytology somewhat intermediate between that of a smooth muscle cell and a Schwann cell. Cells demonstrate diffuse labeling for CD117 (C-Kit) and CD34, but do not label for S-100 protein or desmin. The tumor demonstrated mucosal invasion, another sign of malignancy in GIST.
Discussion: Fibromatosis would be characterized by myofibroblastic cells with extensive collagen deposition and an infiltrative growth pattern. Schwannomas are typically circumscribed lesions surrounded by a lymphoid cuff, and characterized by cells with markedly angulated nuclei, and ill-defined pale cytoplasm. Marked variation in cellularity as well as formation of Antoni B areas with abundant macrophages, lymphocytes, and blood vessels with degenerative changes are typical. Smooth muscle tumors are composed of cells with cigar-shaped, rectangular nuclei with better-defined pink cytoplasm and perinuclear vacuoles, and label for desmin.
Incorrect
Answer: Gastrointestinal stromal tumor (GIST)
Histology: This is a malignant spindle cell lesion characterized by frequent mitoses and extensive areas of necrosis. The cells have a cytology somewhat intermediate between that of a smooth muscle cell and a Schwann cell. Cells demonstrate diffuse labeling for CD117 (C-Kit) and CD34, but do not label for S-100 protein or desmin. The tumor demonstrated mucosal invasion, another sign of malignancy in GIST.
Discussion: Fibromatosis would be characterized by myofibroblastic cells with extensive collagen deposition and an infiltrative growth pattern. Schwannomas are typically circumscribed lesions surrounded by a lymphoid cuff, and characterized by cells with markedly angulated nuclei, and ill-defined pale cytoplasm. Marked variation in cellularity as well as formation of Antoni B areas with abundant macrophages, lymphocytes, and blood vessels with degenerative changes are typical. Smooth muscle tumors are composed of cells with cigar-shaped, rectangular nuclei with better-defined pink cytoplasm and perinuclear vacuoles, and label for desmin.
