A clinicopathologic and immunohistochemical study of gastrointestinal stromal tumors

Ueyama, Toshihiko; Ke, Guo; Hashimoto, Hiroshi; Daimaru, Yutaka; Enjoji, Munetomo

doi:10.1002/1097-0142(19920215)69:4<947::aid-cncr2820690419>3.0.co;2-x

Cited by 269 publications

(161 citation statements)

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“…Over the past few years, it has become increasingly apparent that these tumors need to be studied on a sitespecific basis because of differences in behavior (2,9) and that malignancy is best described in terms of risk factors (10). Although numerous studies have addressed these issues in GIST (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), there has been no study of those rare stromal tumors that develop outside the gastrointestinal tract in the soft tissues of the abdomen with respect to histologic features that predict outcome. A recent study compared a small number of omental and mesenteric GIST with respect to outcome but did not analyze various histologic parameters within these two groups (13).…”

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confidence: 99%

Extragastrointestinal (Soft Tissue) Stromal Tumors: An Analysis of 48 Cases with Emphasis on Histologic Predictors of Outcome

et al. 2000

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The clinicopathologic features of 48 tumors that were histologically similar to gastrointestinal stromal tumors but occurred in the soft tissues of the abdomen were analyzed to determine their overall similarity to their gastrointestinal counterpart, their biologic behavior, and the parameters that predict risk for adverse outcome. Classic leiomyomas and leiomyosarcomas were specifically excluded. The tumors occurred in 32 women and 16 men, who ranged in age from 31 to 82 years (mean, 58 years). Forty tumors arose from the soft tissue of the abdominal cavity, and the remainder arose from the retroperitoneum. They ranged in size from 2.1 to 32.0 cm and varied from tumors composed purely of rounded epithelioid cells to those composed of short fusiform cells set in a fine fibrillary collagenous background with some cases showing a mixed pattern. Tumors displayed variable amounts of stromal hyalinization, myxoid change, and cyst formation. The tumors expressed CD117 (c-kit receptor) (100%), CD34 (50%), neuron-specific enolase (44%), smooth muscle actin (26%), desmin (4%), and S-100 protein (4%). Tumors were evaluated with respect to several parameters: size (<10 cm or >10 cm), cellularity (low or high), mitoses (0 to 2 per 50 high-power fields, >2 per 50 high-power fields), nuclear atypia (1 to 3؉), cell type (epithelioid, spindled, or mixed), and necrosis (absent or present). These parameters were then evaluated in univariate and multivariate analysis with respect to adverse or nonadverse outcome, the former defined as metastasis or death from tumor. Follow-up information was obtained for 31 patients (range, 4 to 84 months; median, 24 months). One patient presented with an adverse event and, therefore, was excluded from subsequent analysis. Twelve patients (39%) developed metastases or died of tumor. In univariate analyses, cellularity, mitotic activity (>2 per 50 high-power fields), and necrosis were associated with statistically significant increases in the risk for adverse outcome. Despite the relatively small sample size, in a multivariable analysis mitotic activity (relative risk, 7.46; P ‫؍‬ .09) and necrosis (relative risk, 3.75; P ‫؍‬ .07) displayed trends toward independent predictive value. Mesenchymal tumors that arise from the wall of the gastrointestinal tract have attracted a great deal of attention over the years. It is generally accepted that those that arise from the esophagus and rectum recapitulate the appearance of mature smooth muscle (1-3), whereas the vast majority of tumors that arise from the remainder of the gastrointestinal

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Extragastrointestinal (Soft Tissue) Stromal Tumors: An Analysis of 48 Cases with Emphasis on Histologic Predictors of Outcome

et al. 2000

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“…These tumors have shown multidirectional differentiation with immature mesenchymal derivatives in some of the tumors [3][4][5][6]. The terms leiomyoma and leimyosarcoma therefore have been gradually replaced by stromal tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of mitotic figures have been accepted uniformly by various authors to separate benign from malignant lesions, but with variable number. However most workers considered unfavourable outcome of the case if the number of mitotic figures were more than 5 in 50 high power fields [2][3][4][5][6][7]16]. Poor prognosis was also predicted, if in addition to the criteria of the tumor size it showed high cellularity, absence of predominant organoid growth pattern and absence of skeinoid fibres on microscopic examination.…”

Section: Discussionmentioning

confidence: 99%

“…Such tumors have been designated as gastrointestinal autonomic nerve (GAN) tumors or plexoma/sarcoma [3][4][5][6]. GAN tumors are considered malignant as these tumors invariably behave aggresively.…”

Section: Discussionmentioning

confidence: 99%

“…Of late, these tumors showed interesting divergent cellular pathways suggestive of smooth muscle, neural and immature mesenchymal differentiations based on the newer diagnostic techniques, such as immunochemistry,and electron microscopy (EM). The histological appearances alone do not reliably reflect the accurate immunophenotypes [5][6][7]. The classiftcation of Gastrointestinal stromal tumors (GISTs) has been the subject of considerable debate, however based on IRC and EM studies carried by numerous authors, these tumors are divided in four major groups [3,8].…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal Stromal Tumours

Chand

Chatterjee

2000

Medical Journal Armed Forces India

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The histogenesis of 10 spindle cell tumors of gastrointestinal tract (GIT) of last three years of our institution was studied, on the basis of immunohistochemical (rnC) staining. The tumours were categorized into benign, borderline malignant and malignant, mainly based on the histologic parameters (HP) such as predominant cell type, cellularity, type of growth pattern, mitotic figures etc. The study included 7 males and 3 females in the age group from 21 to 56 years. 4 tumors were located in stomach and 6 in the small intestine. The initial symptoms included pain abdomen, palpable mass and general weakness. There were 7 benign, 1 borderline and 2 malignant leiomyomatous tumors according to the histologic parameters we followed. Vimentin, desmin, S-100, and non-specific enolase (NSE) were the immunological markers used to identify the cellular lineage. Smooth muscle differentiation was demonstrated by nine (6 benign and 3 malignant) tumours. One male patient (Case 1), originally reported as leiomyoma based on HP, was positive for S-100 and NSE. Another case, a female, categorised as leiomyosarcoma, showed dual differentiation toward myogenic and neural elements on IHC staining (Case 2). IHC study played important role in the identification of cellular differentiation of these tumors as the same was not possible on light microscopic findings alone. MJAFI 2000; 56 : 40-44

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