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Presented by Dr. Pedram Argani and prepared by Dr. Robby Jones
This is a 56 year old male with a gastric tumor.
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1. Question
This is a 56 year old male with a gastric tumor.
Correct
Answer: B
Histology: This is a bland spindle cell lesion centered in the muscularis propria. The neoplastic cells form fascicles, have generally rectangular nuclei, and have pink cytoplasm, all features which suggest smooth muscle differentiation. There are intervening areas of hyalinization and cells with pale cytoplasm. The spindle cells do not show significant atypia or mitotic activity. The lesional cells are diffusely immunoreactive for desmin and caldesmon, which support smooth muscle differentiation. There is abundant staining for CD117 (c-kit) in the tumor. These represent hyperplastic entrapped interstitial cells of Cajal, which has been reported in deep leiomyoma of the esophagus and stomach (Am J Surg Pathol 2014; 38:72-77).
Differential Diagnosis: GIST would feature cells with more angulated nuclei and more diffuse CD117 immunoreactivity. GIST typically do not stain desmin and caldesmon. Leiomyosarcoma would demonstrate greater nuclear atypia and mitotic activity. Schwannomas would not label for desmin, and would feature more angulated nuclei and Verocay bodies.
Incorrect
Answer: B
Histology: This is a bland spindle cell lesion centered in the muscularis propria. The neoplastic cells form fascicles, have generally rectangular nuclei, and have pink cytoplasm, all features which suggest smooth muscle differentiation. There are intervening areas of hyalinization and cells with pale cytoplasm. The spindle cells do not show significant atypia or mitotic activity. The lesional cells are diffusely immunoreactive for desmin and caldesmon, which support smooth muscle differentiation. There is abundant staining for CD117 (c-kit) in the tumor. These represent hyperplastic entrapped interstitial cells of Cajal, which has been reported in deep leiomyoma of the esophagus and stomach (Am J Surg Pathol 2014; 38:72-77).
Differential Diagnosis: GIST would feature cells with more angulated nuclei and more diffuse CD117 immunoreactivity. GIST typically do not stain desmin and caldesmon. Leiomyosarcoma would demonstrate greater nuclear atypia and mitotic activity. Schwannomas would not label for desmin, and would feature more angulated nuclei and Verocay bodies.
