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Presented by Division of Cytopathology and prepared by Marc Lewin, M.D.
Case 6: FNA of a 3.0 cm lesion involving the wall of the stomach in a 37 year old man.
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1. Question
Week 303: Case 6
FNA of a 3.0 cm lesion involving the wall of the stomach in a 37 year old man. The patient is asymptomatic and the mass was discovered incidentally. During the procedure the endoscopist reports that the gastric epithelial surface overlying the lesion appears normal.images/11_21_06_case2_image1.jpg
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images/11_21_06_case2_image5.jpgCorrect
Answer: Heterotopia
Histology: The specimen show scattered benign acinar-type cells. The cells are triangular in shape and are arranged in acinar formations. There are a few hypercellular fragments. Inspection of the edge of the fragments reveals similar appearing acinar-type cells.
Discussion: Gastrointestinal stromal tumor and smooth muscle tumors should certainly be considered in the differential of a mural stomach lesion. However these tumors are usually spindled tumors and there is no cytologic support for either of these entities. The cytology of the aspirated cells is completely benign, thus elimating carcinoma as a consideration. Pancreatic heterotopia is not uncommon in the stomach and certainly explains the findings. Conservative excision confirmed the cytologic diagnosis.
Incorrect
Answer: Heterotopia
Histology: The specimen show scattered benign acinar-type cells. The cells are triangular in shape and are arranged in acinar formations. There are a few hypercellular fragments. Inspection of the edge of the fragments reveals similar appearing acinar-type cells.
Discussion: Gastrointestinal stromal tumor and smooth muscle tumors should certainly be considered in the differential of a mural stomach lesion. However these tumors are usually spindled tumors and there is no cytologic support for either of these entities. The cytology of the aspirated cells is completely benign, thus elimating carcinoma as a consideration. Pancreatic heterotopia is not uncommon in the stomach and certainly explains the findings. Conservative excision confirmed the cytologic diagnosis.
