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A case of a gastrointestinal stromal tumor with skeinoid fibers of the sigmoid colon.

Sumi T, Katsumata K, Shibuya M, Katayanagi S, Iwasaki K, Kasuya K, Serizawa H, Shimazu M, Tsuchida A - Case Rep Gastroenterol (2014)

Bottom Line: MIB-1 positivity was estimated to be as low as approximately 1-2%.We therefore considered the lesion to be a low-risk GIST with skeinoid fibers in the large intestine.Although numerous previous reports have reported skeinoid fibers in the stomach and small intestines, there have been only 9 cases (including the present case) of skeinoid fibers in the large intestine.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery and Transplant Surgery, Tokyo Medical University, Tokyo, Japan.

ABSTRACT
An 80-year-old man was diagnosed with rectal cancer and underwent Hartmann's procedure. Although no tumors were identified during the preoperative examination, gross examination of the resected specimen incidentally revealed a submucosal tumor that was 9 mm in diameter at the oral side and located in the proximal stump of the specimen from the sigmoid colon. We suspected a concurrent gastrointestinal stromal tumor (GIST) and performed a histopathological examination. An L-shaped nodular lesion measuring 9 × 6 mm was histologically composed of a patternless proliferation of spindle cells intermingled with eosinophilic globules. Cellular atypia, prominent mitotic figures and necrotic foci were not observed in the nodule. The spindle cells were positive for CD34, CD117 and vimentin, but negative for CD56, smooth muscle actin and S-100 protein. MIB-1 positivity was estimated to be as low as approximately 1-2%. Electron microscopy showed a bundle of wool-like fibers with a periodicity of approximately 40 nm. We therefore considered the lesion to be a low-risk GIST with skeinoid fibers in the large intestine. Although numerous previous reports have reported skeinoid fibers in the stomach and small intestines, there have been only 9 cases (including the present case) of skeinoid fibers in the large intestine.

No MeSH data available.


Related in: MedlinePlus

a CD34. Spindle cells showed strong positive staining (arrows). 20× original magnification. b CD117. Spindle cells were positive for CD117. 20× original magnification. c Type VI collagen. Globules were positive for type VI collagen (arrows). 20× original magnification. d Vimentin. Spindle cells were positive for vimentin (arrows). 20× original magnification. e CD56. Spindle cells were negative for CD56; positive cells are intermingled with the pre-existing ganglion cells. 20× magnification. f Smooth muscle actin. Spindle cells were negative for smooth muscle actin. 20× magnification. g S-100. Spindle cells were negative for S-100 protein. 20× magnification.
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Figure 2: a CD34. Spindle cells showed strong positive staining (arrows). 20× original magnification. b CD117. Spindle cells were positive for CD117. 20× original magnification. c Type VI collagen. Globules were positive for type VI collagen (arrows). 20× original magnification. d Vimentin. Spindle cells were positive for vimentin (arrows). 20× original magnification. e CD56. Spindle cells were negative for CD56; positive cells are intermingled with the pre-existing ganglion cells. 20× magnification. f Smooth muscle actin. Spindle cells were negative for smooth muscle actin. 20× magnification. g S-100. Spindle cells were negative for S-100 protein. 20× magnification.

Mentions: The histopathological examination was conducted with formalin-fixed paraffin-embedded sections with H&E and immunohistochemical staining. An electron microscopic examination was conducted using an ultrathin section derived from the paraffin-embedded blocks. The histological characteristics of the cancer lesion included an invasive proliferation of atypical cells arranged in a papillotubular structure, suggesting a well-differentiated adenocarcinoma. The lesion reached the subserosal tissue, and focal vascular permeation was observed. Lymph node metastasis was not observed. Although no tumors were identified during the preoperative examination, gross examination of the resected specimen incidentally revealed an L-shaped submucosal nodule measuring 9 × 6 mm on a cut surface of the proximal region located apart from the cancer and near the proximal stump of the resected specimen (fig. 1a, b). An L-shaped well-demarcated nodular lesion was also located in the subserosal layers, and histological examination revealed a patternless proliferation of spindle cells with moderately increased cellularity intermingled with eosinophilic round or club-shaped globules. In addition, there was positive staining for periodic acid-Schiff (PAS) in the globules (fig. 1d). However, we did not observe nuclear atypia, increased mitotic activity or necrotic foci in the lesion. Immunohistochemically, the spindle cells were positive for CD34 (fig. 2a), CD117 (c-kit, fig. 2b) and vimentin (fig. 2d), but negative for CD56 (fig. 2e), smooth muscle actin (fig. 2f) and S-100 protein (fig. 2g). The eosinophilic globules were positive for type VI collagen (fig. 2c). The MIB-1 positivity was estimated to be as low as approximately 1–2%. Electron microscopy of the globules showed a bundle of wool-like fibers with a periodicity of approximately 40 nm (fig. 3). We therefore considered this to be a low-risk GIST with skeinoid fibers (fig. 1b, c).


A case of a gastrointestinal stromal tumor with skeinoid fibers of the sigmoid colon.

Sumi T, Katsumata K, Shibuya M, Katayanagi S, Iwasaki K, Kasuya K, Serizawa H, Shimazu M, Tsuchida A - Case Rep Gastroenterol (2014)

a CD34. Spindle cells showed strong positive staining (arrows). 20× original magnification. b CD117. Spindle cells were positive for CD117. 20× original magnification. c Type VI collagen. Globules were positive for type VI collagen (arrows). 20× original magnification. d Vimentin. Spindle cells were positive for vimentin (arrows). 20× original magnification. e CD56. Spindle cells were negative for CD56; positive cells are intermingled with the pre-existing ganglion cells. 20× magnification. f Smooth muscle actin. Spindle cells were negative for smooth muscle actin. 20× magnification. g S-100. Spindle cells were negative for S-100 protein. 20× magnification.
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Related In: Results  -  Collection

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Figure 2: a CD34. Spindle cells showed strong positive staining (arrows). 20× original magnification. b CD117. Spindle cells were positive for CD117. 20× original magnification. c Type VI collagen. Globules were positive for type VI collagen (arrows). 20× original magnification. d Vimentin. Spindle cells were positive for vimentin (arrows). 20× original magnification. e CD56. Spindle cells were negative for CD56; positive cells are intermingled with the pre-existing ganglion cells. 20× magnification. f Smooth muscle actin. Spindle cells were negative for smooth muscle actin. 20× magnification. g S-100. Spindle cells were negative for S-100 protein. 20× magnification.
Mentions: The histopathological examination was conducted with formalin-fixed paraffin-embedded sections with H&E and immunohistochemical staining. An electron microscopic examination was conducted using an ultrathin section derived from the paraffin-embedded blocks. The histological characteristics of the cancer lesion included an invasive proliferation of atypical cells arranged in a papillotubular structure, suggesting a well-differentiated adenocarcinoma. The lesion reached the subserosal tissue, and focal vascular permeation was observed. Lymph node metastasis was not observed. Although no tumors were identified during the preoperative examination, gross examination of the resected specimen incidentally revealed an L-shaped submucosal nodule measuring 9 × 6 mm on a cut surface of the proximal region located apart from the cancer and near the proximal stump of the resected specimen (fig. 1a, b). An L-shaped well-demarcated nodular lesion was also located in the subserosal layers, and histological examination revealed a patternless proliferation of spindle cells with moderately increased cellularity intermingled with eosinophilic round or club-shaped globules. In addition, there was positive staining for periodic acid-Schiff (PAS) in the globules (fig. 1d). However, we did not observe nuclear atypia, increased mitotic activity or necrotic foci in the lesion. Immunohistochemically, the spindle cells were positive for CD34 (fig. 2a), CD117 (c-kit, fig. 2b) and vimentin (fig. 2d), but negative for CD56 (fig. 2e), smooth muscle actin (fig. 2f) and S-100 protein (fig. 2g). The eosinophilic globules were positive for type VI collagen (fig. 2c). The MIB-1 positivity was estimated to be as low as approximately 1–2%. Electron microscopy of the globules showed a bundle of wool-like fibers with a periodicity of approximately 40 nm (fig. 3). We therefore considered this to be a low-risk GIST with skeinoid fibers (fig. 1b, c).

Bottom Line: MIB-1 positivity was estimated to be as low as approximately 1-2%.We therefore considered the lesion to be a low-risk GIST with skeinoid fibers in the large intestine.Although numerous previous reports have reported skeinoid fibers in the stomach and small intestines, there have been only 9 cases (including the present case) of skeinoid fibers in the large intestine.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery and Transplant Surgery, Tokyo Medical University, Tokyo, Japan.

ABSTRACT
An 80-year-old man was diagnosed with rectal cancer and underwent Hartmann's procedure. Although no tumors were identified during the preoperative examination, gross examination of the resected specimen incidentally revealed a submucosal tumor that was 9 mm in diameter at the oral side and located in the proximal stump of the specimen from the sigmoid colon. We suspected a concurrent gastrointestinal stromal tumor (GIST) and performed a histopathological examination. An L-shaped nodular lesion measuring 9 × 6 mm was histologically composed of a patternless proliferation of spindle cells intermingled with eosinophilic globules. Cellular atypia, prominent mitotic figures and necrotic foci were not observed in the nodule. The spindle cells were positive for CD34, CD117 and vimentin, but negative for CD56, smooth muscle actin and S-100 protein. MIB-1 positivity was estimated to be as low as approximately 1-2%. Electron microscopy showed a bundle of wool-like fibers with a periodicity of approximately 40 nm. We therefore considered the lesion to be a low-risk GIST with skeinoid fibers in the large intestine. Although numerous previous reports have reported skeinoid fibers in the stomach and small intestines, there have been only 9 cases (including the present case) of skeinoid fibers in the large intestine.

No MeSH data available.


Related in: MedlinePlus