Gastrointestinal tract spindle cell lesions—just like real estate, it's all about location

Abstract

Interpretation of gastrointestinal tract mesenchymal lesions is simplified merely by knowing in which anatomic layer they are usually found. For example, Kaposi sarcoma is detected on mucosal biopsies, whereas inflammatory fibroid polyp is nearly always in the submucosa. Gastrointestinal stromal tumors (GISTs) are generally centered in the muscularis propria. Schwannomas are essentially always in the muscularis propria. Mesenteric lesions are usually found in the small bowel mesentery. Knowledge of the favored layer is even most important in interpreting colon biopsies, as many mesenschymal polyps are encountered in the colon. Although GISTs are among the most common mesenchymal lesions, we will concentrate our discussion on other mesenchymal lesions, some of which are in the differential diagnosis of GIST, and point out some diagnostic pitfalls, particularly in immunolabeling.

Endoscopic ultrasound FNA: An illustrated review of spindle cell neoplasms of the upper gastrointestinal tract including a novel case of gastric plexiform fibromyxoma

“…Ancillary immunohistochemical characterization of upper GI spindle cell proliferations may trigger definitive rather than descriptive diagnoses on small samples (Table ) and may allow for separation of GISTs, leiomyomata, schwannomas, carcinoid tumors, and PFs. It should also be noted that other spindle cell lesions, including but not necessarily limited to desmoid‐type fibromatoses, inflammatory fibroid polyps, and solitary fibrous tumors may enter the differential diagnosis . The upper GI tract is less frequently biopsied in comparison to other sites in larger EUS series; however, EUS with FNA and/or core biopsy is known to be an effective modality for the diagnosis of upper tract submucosal and spindle cell lesions .…”

“…They are usually detected incidentally, including but not necessarily limited to desmoid-type fibromatoses, inflammatory fibroid polyps, and solitary fibrous tumors may enter the differential diagnosis. [56][57][58][59][60][61][62] The upper GI tract is less frequently biopsied in comparison to other sites in larger EUS series; however, EUS with FNA and/or core biopsy is known to be an effective modality for the diagnosis of upper tract submucosal and spindle cell lesions. [63][64][65][66] Recent studies have suggested higher diagnostic accuracy with newer EUS coring needles, as well as the advantage of establishing diagnoses with fewer passes.…”

Histopathological spectrum of spindle cell tumours of gastro-intestinal tract

“…GISTs are occasionally diagnosed on mucosal biopsy if the lesion is too aggressive to have invaded mucosa. 2 GISTs are most common in adults of 50-60 years and about 25% of GISTs are malignant, representing almost 1% of all GI malignancies. 7 According to the location, oesophageal GISTs are rare, 50-70% are seen in the stomach; 25-40% involve the small intestine and <10% are colorectal.…”

“…Most patients are in the age group of 60 and 80 years. 2,10 Clinical presentation is based on the site of the tumour thus the small intestinal examples can lead to intussusception or obstruction, and gastric examples are found in patients with pain, nausea, and vomiting. 11 Inflammatory fibroid polyps were reported in a family in which three generations of women had these 'Devon polyposis' lesions.…”

The pathology and causes of tissue eosinophilia in the gastrointestinal tract

“…IFP, a benign mesenchymal neoplasm of the stomach, small bowel, and, occasionally, the colon, is often associated with an inflammatory infiltrate rich in eosinophils (Figure ). IFPs are centred in the submucosa, but can infiltrate the overlying lamina propria, so that superficial biopsies of the lesion might result in confusion with an eosinophilic disorder.…”