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Cytokeratin-positive gastrointestinal stromal tumor of biphasic morphology: a case report.

Kim SS, Choi YD, Lee JH, Choi C - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Chonnam National University Medical School, Gwangju, Korea.

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Gastrointestinal stromal tumor (GIST), which is associated with mutations in KIT or a platelet-derived growth factor receptor, alpha polypeptide (PDGFRA), is the most common mesenchymal tumor of the gastrointestinal tract... In such cases, a diagnosis of GIST can be made when DOG1 immunoreactivity or mutation of KIT or PDGFRA are observed... A 44-year-old man was referred for evaluation of pain in his right foot... Laboratory test results, including electrolyte levels and blood-cell counts, were all within normal range... There was no transition area between the epithelioid and spindle-cell areas (Fig. 2A)... Mitotic figures were found at more than 10 per 50 high-power fields in both epithelioid and spindle-cell areas... Interestingly, the expressions of CD34 and CK were mutually exclusive between the epithelioid and spindle-cell areas... Direct sequencing of the KIT gene was performed in both sense and antisense directions in order to verify the results, using formalin-fixed, paraffin-embedded tissue from both areas and an ABI Prism 3100 Genetic Analyzer (Applied Biosystems, Grand Island, NY, USA), following the supplier’s recommendations... CK expression in GIST using monoclonal CK antibodies, such as CK18 or CK8, has been evaluated in several studies, and these studies support the conclusion that CK-immunoreactivity is more frequently noted in the epithelioid area than in the spindle-cell area (Table 1)... Thus, it seems that a higher rate of CK-immunoreactivity in epithelioid GIST might be due to a selection bias... In addition to GIST, CK-positivity has been observed in some mesenchymal tumors with epithelioid morphology, such as epithelioid angiosarcoma, epithelioid sarcoma, Ewing’s sarcoma/primitive neuroectodermal tumor, leiomyosarcoma, or schwannoma... Aberrant expression of CK is known to be a result of aberrant synthesis of CK by tumor cells or cross-reactivity to other intermediate filament proteins... We presented a case of GIST with a biphasic (mixed epithelioid and spindle cells) phenotype and distinct immunohistochemical profiles... CK immunoreactivity in the epithelioid area can be a diagnostic challenge unless tumor cells reveal immunoreactivity for c-Kit and DOG1.

No MeSH data available.


The epithelioid lesion is immunopositive for CK (A, B) and immunonegative for CD34 (D, E). The spindle cell area is immunoreactive for CD34 (D, F) and immunonegative for CK (A, C).
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f3-kjpathol-48-5-375: The epithelioid lesion is immunopositive for CK (A, B) and immunonegative for CD34 (D, E). The spindle cell area is immunoreactive for CD34 (D, F) and immunonegative for CK (A, C).

Mentions: Immunohistochemistry was performed in an autostainer (BOND-MAX, Leica Biosystems, Nussloch, Germany) using the following primary antibodies: anti-c-Kit (1:50, polyclonal, Dako, Glostrup, Denmark), anti-CD34 (1:200, QBEnd10, Dako), anti-CK (1:200, AE1/AE3, Dako), and anti-DOG1 (1:100, K9, Novocastra, Newcastle Upon Tyne, UK). The epithelioid cells were immunoreactive for CK, c-Kit, and DOG1 but not for CD34. The spindle cells were immunoreactive for c-Kit, DOG1, and CD34, but not for CK (Figs. 2, 3). There was a subtle difference in intensity of c-Kit staining between the epithelioid and spindle cells (Fig. 2D). Interestingly, the expressions of CD34 and CK were mutually exclusive between the epithelioid and spindle-cell areas. Direct sequencing of the KIT gene was performed in both sense and antisense directions in order to verify the results, using formalin-fixed, paraffin-embedded tissue from both areas and an ABI Prism 3100 Genetic Analyzer (Applied Biosystems, Grand Island, NY, USA), following the supplier’s recommendations. Sequencing revealed mutations in exon 11 codon 557 of the KIT gene in both areas. At a two-month follow-up appointment, multiple liver nodules with low attenuation were detected by abdominal CT, which were thought to be metastatic lesions. At an 18-month follow-up appointment, abdominopelvic CT revealed no change in size or attenuation of the nodules. The patient had been treated regularly with imatinib mesylate, and there was no evidence of tumor progression at 78 months after the operation.


Cytokeratin-positive gastrointestinal stromal tumor of biphasic morphology: a case report.

Kim SS, Choi YD, Lee JH, Choi C - Korean J Pathol (2014)

The epithelioid lesion is immunopositive for CK (A, B) and immunonegative for CD34 (D, E). The spindle cell area is immunoreactive for CD34 (D, F) and immunonegative for CK (A, C).
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Related In: Results  -  Collection

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f3-kjpathol-48-5-375: The epithelioid lesion is immunopositive for CK (A, B) and immunonegative for CD34 (D, E). The spindle cell area is immunoreactive for CD34 (D, F) and immunonegative for CK (A, C).
Mentions: Immunohistochemistry was performed in an autostainer (BOND-MAX, Leica Biosystems, Nussloch, Germany) using the following primary antibodies: anti-c-Kit (1:50, polyclonal, Dako, Glostrup, Denmark), anti-CD34 (1:200, QBEnd10, Dako), anti-CK (1:200, AE1/AE3, Dako), and anti-DOG1 (1:100, K9, Novocastra, Newcastle Upon Tyne, UK). The epithelioid cells were immunoreactive for CK, c-Kit, and DOG1 but not for CD34. The spindle cells were immunoreactive for c-Kit, DOG1, and CD34, but not for CK (Figs. 2, 3). There was a subtle difference in intensity of c-Kit staining between the epithelioid and spindle cells (Fig. 2D). Interestingly, the expressions of CD34 and CK were mutually exclusive between the epithelioid and spindle-cell areas. Direct sequencing of the KIT gene was performed in both sense and antisense directions in order to verify the results, using formalin-fixed, paraffin-embedded tissue from both areas and an ABI Prism 3100 Genetic Analyzer (Applied Biosystems, Grand Island, NY, USA), following the supplier’s recommendations. Sequencing revealed mutations in exon 11 codon 557 of the KIT gene in both areas. At a two-month follow-up appointment, multiple liver nodules with low attenuation were detected by abdominal CT, which were thought to be metastatic lesions. At an 18-month follow-up appointment, abdominopelvic CT revealed no change in size or attenuation of the nodules. The patient had been treated regularly with imatinib mesylate, and there was no evidence of tumor progression at 78 months after the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Chonnam National University Medical School, Gwangju, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Gastrointestinal stromal tumor (GIST), which is associated with mutations in KIT or a platelet-derived growth factor receptor, alpha polypeptide (PDGFRA), is the most common mesenchymal tumor of the gastrointestinal tract... In such cases, a diagnosis of GIST can be made when DOG1 immunoreactivity or mutation of KIT or PDGFRA are observed... A 44-year-old man was referred for evaluation of pain in his right foot... Laboratory test results, including electrolyte levels and blood-cell counts, were all within normal range... There was no transition area between the epithelioid and spindle-cell areas (Fig. 2A)... Mitotic figures were found at more than 10 per 50 high-power fields in both epithelioid and spindle-cell areas... Interestingly, the expressions of CD34 and CK were mutually exclusive between the epithelioid and spindle-cell areas... Direct sequencing of the KIT gene was performed in both sense and antisense directions in order to verify the results, using formalin-fixed, paraffin-embedded tissue from both areas and an ABI Prism 3100 Genetic Analyzer (Applied Biosystems, Grand Island, NY, USA), following the supplier’s recommendations... CK expression in GIST using monoclonal CK antibodies, such as CK18 or CK8, has been evaluated in several studies, and these studies support the conclusion that CK-immunoreactivity is more frequently noted in the epithelioid area than in the spindle-cell area (Table 1)... Thus, it seems that a higher rate of CK-immunoreactivity in epithelioid GIST might be due to a selection bias... In addition to GIST, CK-positivity has been observed in some mesenchymal tumors with epithelioid morphology, such as epithelioid angiosarcoma, epithelioid sarcoma, Ewing’s sarcoma/primitive neuroectodermal tumor, leiomyosarcoma, or schwannoma... Aberrant expression of CK is known to be a result of aberrant synthesis of CK by tumor cells or cross-reactivity to other intermediate filament proteins... We presented a case of GIST with a biphasic (mixed epithelioid and spindle cells) phenotype and distinct immunohistochemical profiles... CK immunoreactivity in the epithelioid area can be a diagnostic challenge unless tumor cells reveal immunoreactivity for c-Kit and DOG1.

No MeSH data available.