Cytomorphology of gastrointestinal stromal tumours: a comprehensive study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20151596Keywords:
Cytology, Gastrointestinal stromal tumours, Malignant tumoursAbstract
Background: Gastrointestinal stromal tumours (GIST) are a heterogenous group of neoplasms. The main aim of the study is to review cases of spindle cell and epithelioid cell neoplasms of the GI tract and classify them as GIST and Non GIST morphologically.
Methods: The present study included 30 cases of ‘gastrointestinal stromal tumours (GIST). GIST cases were reviewed based on morphology and were classified into “Risk of metastasis” categories based on the size and mitotic activity.
Results: The small intestine was the most commonly involved site (46.67%), followed by stomach (30%). Based on the size of the tumour and mitotic activity, the tumours were categorized as high risk (70%), intermediate risk (16.67%), low risk (6.67%), and very low risk (6.67%). High risk tumours predominated in all sites except the oesophagus. There was spindle cell predominance (76.8%) among all the cases. Epithelioid cells were seen in 36.7% of the cases.
Conclusions: Identifying mitotic figures and counting of GIST was associated with problems and were due to uneven distribution of the mitotic figures, variable thickness of the section and presence of inflammatory cells. Inspite of the difficulty mitoses is still considered as a good prognostic marker.
References
Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach. A clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005;29:52-68.
Miettinen M, Virolainen M, Sarlomo-Rikala M. Gastrointestinal stromal tumors: Value of CD 34 antigen in their identification and separation from true leiomyomas and schwannomas. Am J Surg Pathol. 1995;19: 207-16.
Fletcher CDM, Berman JJ, Corless C. Diagnosis of Gastrointestinal Stromal Tumors: A Consensus Approach. Hum Pathol. 2002;33:459-65.
Paul K, Merkelbach-Bruse S, Thal D, Buttner R & Wardelmann E. PDGFRα- and c-KIT-mutated gastrointestinal stromal tumours (GISTs) are characterized by distinctive histological and immunhistochemical features. Histopathology. 2005;46:166-75.
Evans HL. Smooth Muscle Tumors of the Gastrointestinal Tract: A Study of 56 Cases followed for a Minimum of 10 Years. Cancer. 1985;56:2242-50.
Nada R, Vaiphei K, Singh R, Wig JD, Gupta NM, Banerjee AK. Gastrointestinal stromal tumours the assessment of malignant potential. Indian J Pathol Microbiol. 2001;44:393-7.
Franquemont DW, Frierson HF. Muscle Differentiation and Clinicopathologic Features of Gastrointestinal Stromal Tumors. Am J Surg Pathol. 1992;16:947-54.
Ranchod M, Kempson RL. Smooth Muscle Tumors of the Gastrointestinal Tract and Retroperitoneum. Cancer. 1977;39:255-62.
Haque S, Dean PJ. Stromal Neoplasms of the Rectum and Anal Canal. Hum Pathol. 1992;23:762-7.
Miettinen M, El-Rifai W, Sobin LH, Lasota J. Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Hum Pathol. 2002;33:478-83.
Roy M, Sommers SC. Metastatic potential of gastric leoimyosarcoma. Pathol Res Pract. 1989;185:874-7.
Berman J, O’Leary TJ. Gastrointestinal Stromal Tumor Workshop. Hum Pathol. 2001;32:578-82.
Ranchod M and Kempson RL. Smooth Muscle Tumors of the Gastrointestinal Tract and Retroperitoneum. Cancer. 1977;39:255-62.
Akwari OE, Dozois RR, Weiland LH, Beahrs OH. Leiomyosarcoma of the small and large bowel. Cancer. 1978;42(3):1375-84.
Brainard JA, Goldblum JR. Stromal Tumors of the Jejunum and Ileum: A Clinicopathologic Study of 39 Cases. Am J Surg Pathol. 1997;21:407-16.
Goldblum JR, Appelman HD. Stromal Tumors of the Duodenum: A Histologic and Immunohistochemical Study of 20 Cases. Am J Surg Pathol. 1995;19:71-80.
Ma CK, De Peralta MN, Amin MB, Linden MD, Dekovich AA, Kubus JJ. Small Intestinal Stromal Tumors A Clinicopathologic Study of 20 Cases With Immunohistochemical Assessment of Cell Differentiation and the Prognostic Role of Proliferation Antigens. Am J Clin Pathol. 1997;108:641-51.