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Presented by Pedram Argani, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 3: 39 year old female with gastrointestinal bleeding.
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1. Question
Week 336: Case 3
39 year old female with gastrointestinal bleeding./images/1_21_08 3A.jpg
/images/1_21_08 3B.jpg
/images/1_21_08 3C.jpg
/images/1_21_08 3D.jpgCorrect
Answer: Gastrointestinal stromal tumor
Histology: The tumor consists of short fascicles of bland spindle cells, involving the full thickness of the bowel wall. The tumor also ulcerates the mucosa, penetrates through the muscularis propria, and reaches the surface. This tumor measured 2.5 cm, and had a mitotic count of 8 per 50 high power fields. Using established criteria, this predicts a high risk of metastases.
Discussion: A schwannoma is of the GI tract would feature bland spindle cell with angulated nuclei, but frequently has a lymphoid cuff about it. They typically do not label for c-kit, but do label diffusely for S100 protein. Leiomyosarcomas typically label diffusely for actin and desmin, but not for c-kit. Fibromatosis have more infiltrative growth pattern, and paler cytoplasm. These tumor cells will label for beta-catenin in a nuclear fashion, and typically do not label for c-kit.
The behavior of gastrointestinal stromal tumors (GIST) is difficult to predict. Matched by size and mitotic activity, GIST of the small bowel are more likely to behave in a malignant fashion than those of the stomach.
Reference(s):
– Archives of Pathology and Laboratory Medicine 2006; 130:1466-1478.Incorrect
Answer: Gastrointestinal stromal tumor
Histology: The tumor consists of short fascicles of bland spindle cells, involving the full thickness of the bowel wall. The tumor also ulcerates the mucosa, penetrates through the muscularis propria, and reaches the surface. This tumor measured 2.5 cm, and had a mitotic count of 8 per 50 high power fields. Using established criteria, this predicts a high risk of metastases.
Discussion: A schwannoma is of the GI tract would feature bland spindle cell with angulated nuclei, but frequently has a lymphoid cuff about it. They typically do not label for c-kit, but do label diffusely for S100 protein. Leiomyosarcomas typically label diffusely for actin and desmin, but not for c-kit. Fibromatosis have more infiltrative growth pattern, and paler cytoplasm. These tumor cells will label for beta-catenin in a nuclear fashion, and typically do not label for c-kit.
The behavior of gastrointestinal stromal tumors (GIST) is difficult to predict. Matched by size and mitotic activity, GIST of the small bowel are more likely to behave in a malignant fashion than those of the stomach.
Reference(s):
– Archives of Pathology and Laboratory Medicine 2006; 130:1466-1478.
