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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

Smear showing groups of epithelioid tumors cells with round nuclei (MGG, ×200); (a) Multinucleation (MGG, ×400); (b) Plasmacytoid tumor cells displaying eccentric round nuclei with smooth nuclear membrane and fine chromatin (MGG, ×400); (c) Acinar arrangement of tumor cells mimicking epithelial tumor (MGG, ×400); (d) (Inset: Mitotic figure in a mixed GIST (MGG, ×400)
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Figure 2: Smear showing groups of epithelioid tumors cells with round nuclei (MGG, ×200); (a) Multinucleation (MGG, ×400); (b) Plasmacytoid tumor cells displaying eccentric round nuclei with smooth nuclear membrane and fine chromatin (MGG, ×400); (c) Acinar arrangement of tumor cells mimicking epithelial tumor (MGG, ×400); (d) (Inset: Mitotic figure in a mixed GIST (MGG, ×400)

Mentions: Focal to diffuse epithelioid cell morphology admixed with spindle cells were observed in twelve samples and 3 tumors had only epithelioid cell type [Figure 2a]. Epithelioid morphology was more commonly seen in malignant and metastatic tumors. Binucleation and multinucleation was noted [Figure 2b]. Plasmacytoid appearance was noted in eight samples [Figure 2c] Few demonstrated rossetting and acinar structure arrangement reminiscent of adenocarcinoma [Figure 2d]. These cells displayed round nuclei with regular to irregular nuclear membrane. The nucleoli were indistinct in low grade tumors and prominent or multiple nucleoli were seen in high grade tumors irrelevant of cell type. Intranuclear inclusions were also noted in malignant tumors. The presence of marked cytologic atypia with presence of bizarre and giant cells was identified in 6 tumors. Occasional tumors displayed bubbly appearance due to multiple cytoplasmic vacuoles. In 9 cases mitotic figures were observed. The pleural and ascitic fluid cytology smears exhibited loosely formed aggregates with epithelioid cell morphology. Nuclear pleomorphism, opened up chromatin, conspicuous nucleoli were noted. Necrosis was appreciated in a primary retroperitoneal tumor and in ascitic fluid specimen.


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)

Smear showing groups of epithelioid tumors cells with round nuclei (MGG, ×200); (a) Multinucleation (MGG, ×400); (b) Plasmacytoid tumor cells displaying eccentric round nuclei with smooth nuclear membrane and fine chromatin (MGG, ×400); (c) Acinar arrangement of tumor cells mimicking epithelial tumor (MGG, ×400); (d) (Inset: Mitotic figure in a mixed GIST (MGG, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Smear showing groups of epithelioid tumors cells with round nuclei (MGG, ×200); (a) Multinucleation (MGG, ×400); (b) Plasmacytoid tumor cells displaying eccentric round nuclei with smooth nuclear membrane and fine chromatin (MGG, ×400); (c) Acinar arrangement of tumor cells mimicking epithelial tumor (MGG, ×400); (d) (Inset: Mitotic figure in a mixed GIST (MGG, ×400)
Mentions: Focal to diffuse epithelioid cell morphology admixed with spindle cells were observed in twelve samples and 3 tumors had only epithelioid cell type [Figure 2a]. Epithelioid morphology was more commonly seen in malignant and metastatic tumors. Binucleation and multinucleation was noted [Figure 2b]. Plasmacytoid appearance was noted in eight samples [Figure 2c] Few demonstrated rossetting and acinar structure arrangement reminiscent of adenocarcinoma [Figure 2d]. These cells displayed round nuclei with regular to irregular nuclear membrane. The nucleoli were indistinct in low grade tumors and prominent or multiple nucleoli were seen in high grade tumors irrelevant of cell type. Intranuclear inclusions were also noted in malignant tumors. The presence of marked cytologic atypia with presence of bizarre and giant cells was identified in 6 tumors. Occasional tumors displayed bubbly appearance due to multiple cytoplasmic vacuoles. In 9 cases mitotic figures were observed. The pleural and ascitic fluid cytology smears exhibited loosely formed aggregates with epithelioid cell morphology. Nuclear pleomorphism, opened up chromatin, conspicuous nucleoli were noted. Necrosis was appreciated in a primary retroperitoneal tumor and in ascitic fluid specimen.

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