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Cytomorphology of gastrointestinal stromal tumors and extra-gastrointestinal stromal tumors: A comprehensive morphologic study.

Vij M, Agrawal V, Kumar A, Pandey R - J Cytol (2013)

Bottom Line: The smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels.The tumor cells were mild to moderately pleomorphic, spindle to epithelioid with variable chromatin pattern and variable cytoplasm.Cellular dyscohesion, nuclear pleomorphism, intranuclear pseudoinclusions, prominent nucleoli, mitosis and necrosis were more prominent in malignant, metastatic and recurrent tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Global Hospitals and Health City, Chennai, Tamil Nadu, India.

ABSTRACT

Background: The term gastrointestinal stromal tumors (GIST) is used to refer to those mesenchymal neoplasms of the gastrointestinal tract (GIT) which express CD117, a c-kit proto-oncogene protein.

Aims: To study the cytological features of GIST and extra-gastrointestinal stromal tumors (EGIST), to correlate them with histology and to determine cytological indicators of malignancy.

Materials and methods: Cytological smears from patients diagnosed as GIST/EGIST on histology were retrieved. From Jan 2000 to July 2010, 26 GIST (13 primary, 12 metastatic, one recurrent) and seven EGIST (5 primary, one metastatic, one recurrent) cytologic samples from 27 patients were identified.

Results: The patients included 20 males and 7 females with a mean age of 50.6 years. Tumor sites included stomach (5), duodenum (5), ileum (2), ileocecal (1), rectum (1), liver (9), retroperitoneum (5), mesentery (1), subcutaneous nodule (1), supra-penile lump (1), ascitic (1) and pleural fluids (1). The smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels. The tumor cells were mild to moderately pleomorphic, spindle to epithelioid with variable chromatin pattern and variable cytoplasm. Cellular dyscohesion, nuclear pleomorphism, intranuclear pseudoinclusions, prominent nucleoli, mitosis and necrosis were more prominent in malignant, metastatic and recurrent tumors.

Conclusions: GISTs show a wide spectrum of cytological features and the presence of mitosis, necrosis and nuclear pleomorphism can help in prediction of malignant behavior. Further, cytology is a very useful screening modality in patients of GIST and EGIST to detect early recurrence and metastasis at follow-up.

No MeSH data available.


Related in: MedlinePlus

Spindle cells with high cellularity, closely packed to loose clusters and dyscohesive cells (MGG, ×100); (a) Spindle cells displaying elongated to wavy nuclei with blunt to tapered ends (MGG, ×200); (b) Fascicles with parallel, side-by-side arrangements of nuclei with scant cytoplasm. Nuclear palisading is also observed (MGG, ×100); (c) Abundant extracellular stromal material (MGG, ×200); (d) (Inset: Spindle cells with bipolar cytoplasmic processes (MGG, ×400)
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Figure 1: Spindle cells with high cellularity, closely packed to loose clusters and dyscohesive cells (MGG, ×100); (a) Spindle cells displaying elongated to wavy nuclei with blunt to tapered ends (MGG, ×200); (b) Fascicles with parallel, side-by-side arrangements of nuclei with scant cytoplasm. Nuclear palisading is also observed (MGG, ×100); (c) Abundant extracellular stromal material (MGG, ×200); (d) (Inset: Spindle cells with bipolar cytoplasmic processes (MGG, ×400)

Mentions: The smears were variably cellular. Low grade tumors were more commonly low to moderately cellular. Malignant and metastatic lesions were commonly highly cellular. In patients with predominantly spindle cells on cytology (n = 18) smears showed cells often arranged in cohesive to loose three dimensional clusters and singly scattered or dispersed cells [Figure 1a and b]. The tumor cells often formed fascicles with parallel, side-by-side arrangements of nuclei. In these fascicles tumor cells were oriented or organized in one direction (streaming). Nuclear palisading was found in eight cases [Figure 1c]. The stroma of the cohesive sheets present between the nuclei was loosely fibrillary and stained pink to magenta on MGG [Figure 1d]. The tumor cells had, ovoid to elongated or irregular-shaped nuclei. The chromatin was finely to coarsely granular. The cytoplasm had a distinctive delicate fibrillary quality with numerous wispy cytoplasmic extensions. Bipolar cytoplasmic processes were often observed in spindle cell tumors. Cytoplasmic vacuoles were sometimes seen in perinuclear location. Extra-cellular myxoid material was also present. Skenoid fibres were noted in a smear from liver metastasis of a patient with primary jejunal GIST. Focally, tumors exhibited vascular patterns with tumor cells arranged as perivascular clusters. Many tumors also showed “stripped” or “bare” spindle nuclei in background.


Cytomorphology of gastrointestinal stromal tumors and extra-gastrointestinal stromal tumors: A comprehensive morphologic study.

Vij M, Agrawal V, Kumar A, Pandey R - J Cytol (2013)

Spindle cells with high cellularity, closely packed to loose clusters and dyscohesive cells (MGG, ×100); (a) Spindle cells displaying elongated to wavy nuclei with blunt to tapered ends (MGG, ×200); (b) Fascicles with parallel, side-by-side arrangements of nuclei with scant cytoplasm. Nuclear palisading is also observed (MGG, ×100); (c) Abundant extracellular stromal material (MGG, ×200); (d) (Inset: Spindle cells with bipolar cytoplasmic processes (MGG, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643373&req=5

Figure 1: Spindle cells with high cellularity, closely packed to loose clusters and dyscohesive cells (MGG, ×100); (a) Spindle cells displaying elongated to wavy nuclei with blunt to tapered ends (MGG, ×200); (b) Fascicles with parallel, side-by-side arrangements of nuclei with scant cytoplasm. Nuclear palisading is also observed (MGG, ×100); (c) Abundant extracellular stromal material (MGG, ×200); (d) (Inset: Spindle cells with bipolar cytoplasmic processes (MGG, ×400)
Mentions: The smears were variably cellular. Low grade tumors were more commonly low to moderately cellular. Malignant and metastatic lesions were commonly highly cellular. In patients with predominantly spindle cells on cytology (n = 18) smears showed cells often arranged in cohesive to loose three dimensional clusters and singly scattered or dispersed cells [Figure 1a and b]. The tumor cells often formed fascicles with parallel, side-by-side arrangements of nuclei. In these fascicles tumor cells were oriented or organized in one direction (streaming). Nuclear palisading was found in eight cases [Figure 1c]. The stroma of the cohesive sheets present between the nuclei was loosely fibrillary and stained pink to magenta on MGG [Figure 1d]. The tumor cells had, ovoid to elongated or irregular-shaped nuclei. The chromatin was finely to coarsely granular. The cytoplasm had a distinctive delicate fibrillary quality with numerous wispy cytoplasmic extensions. Bipolar cytoplasmic processes were often observed in spindle cell tumors. Cytoplasmic vacuoles were sometimes seen in perinuclear location. Extra-cellular myxoid material was also present. Skenoid fibres were noted in a smear from liver metastasis of a patient with primary jejunal GIST. Focally, tumors exhibited vascular patterns with tumor cells arranged as perivascular clusters. Many tumors also showed “stripped” or “bare” spindle nuclei in background.

Bottom Line: The smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels.The tumor cells were mild to moderately pleomorphic, spindle to epithelioid with variable chromatin pattern and variable cytoplasm.Cellular dyscohesion, nuclear pleomorphism, intranuclear pseudoinclusions, prominent nucleoli, mitosis and necrosis were more prominent in malignant, metastatic and recurrent tumors.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Global Hospitals and Health City, Chennai, Tamil Nadu, India.

ABSTRACT

Background: The term gastrointestinal stromal tumors (GIST) is used to refer to those mesenchymal neoplasms of the gastrointestinal tract (GIT) which express CD117, a c-kit proto-oncogene protein.

Aims: To study the cytological features of GIST and extra-gastrointestinal stromal tumors (EGIST), to correlate them with histology and to determine cytological indicators of malignancy.

Materials and methods: Cytological smears from patients diagnosed as GIST/EGIST on histology were retrieved. From Jan 2000 to July 2010, 26 GIST (13 primary, 12 metastatic, one recurrent) and seven EGIST (5 primary, one metastatic, one recurrent) cytologic samples from 27 patients were identified.

Results: The patients included 20 males and 7 females with a mean age of 50.6 years. Tumor sites included stomach (5), duodenum (5), ileum (2), ileocecal (1), rectum (1), liver (9), retroperitoneum (5), mesentery (1), subcutaneous nodule (1), supra-penile lump (1), ascitic (1) and pleural fluids (1). The smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels. The tumor cells were mild to moderately pleomorphic, spindle to epithelioid with variable chromatin pattern and variable cytoplasm. Cellular dyscohesion, nuclear pleomorphism, intranuclear pseudoinclusions, prominent nucleoli, mitosis and necrosis were more prominent in malignant, metastatic and recurrent tumors.

Conclusions: GISTs show a wide spectrum of cytological features and the presence of mitosis, necrosis and nuclear pleomorphism can help in prediction of malignant behavior. Further, cytology is a very useful screening modality in patients of GIST and EGIST to detect early recurrence and metastasis at follow-up.

No MeSH data available.


Related in: MedlinePlus