Best Practices in Diagnostic Immunohistochemistry: Spindle Cell Neoplasms of the Gastrointestinal Tract

2009 ◽  
Vol 133 (9) ◽  
pp. 1370-1374
Author(s):  
Matthew S. Turner ◽  
Jeffrey D. Goldsmith
Keyword(s):  
Smooth Muscle ◽  
Gastrointestinal Tract ◽  
Best Practices ◽  
Spindle Cell ◽  
Smooth Muscle Actin ◽  
English Literature ◽  
S100 Protein ◽  
Spindle Cell Neoplasm ◽  
Smooth Muscle Tumors

Abstract Context.—The proper classification of spindle cell neoplasms of the gastrointestinal tract frequently requires the use of immunohistochemistry, as the histologic appearance of these lesions often overlaps. Objective.—To review the antibodies used in the diagnosis of spindle cell neoplasms of the gastrointestinal tract, and to outline an approach to the evaluation of these lesions by using immunohistochemistry. Data Sources.—The authors' experience and a review of the English literature from 1976 to 2008. Conclusions.—The most common spindle cell neoplasm of the gastrointestinal tract is gastrointestinal stromal tumor; this lesion is readily diagnosed with c-kit immunohistochemistry in most cases. Other stains, such as smooth muscle actin, desmin, S100 protein, and β-catenin, are also useful in the diagnosis of smooth muscle tumors, schwannomas, desmoid-type fibromatoses, and metastatic melanoma.

scholarly journals Do GISTs Occur in Rats and Mice? Immunohistochemical Characterization of Gastrointestinal Tumors Diagnosed as Smooth Muscle Tumors in The National Toxicology Program

2019 ◽  
Vol 47 (5) ◽  
pp. 577-584
Author(s):  
Kyathanahalli S. Janardhan ◽  
Priyanka Venkannagari ◽  
Heather Jensen ◽  
Mark J. Hoenerhoff ◽  
Ronald A. Herbert ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Cell Morphology ◽  
Spindle Cell ◽  
Smooth Muscle Actin ◽  
Gi Tract ◽  
Toxicological Studies ◽  
Smooth Muscle Tumors ◽  
Hematoxylin And Eosin ◽  
Cells Of Cajal ◽  
Rats And Mice

The majority of the tumors in the gastrointestinal (GI) tract of rats and mice, with spindle cell morphology, are diagnosed as smooth muscle tumors (SMTs). Similarly, several decades ago human GI tumors with spindle cell morphology were also diagnosed as SMTs. However, later investigations identified most of these tumors in humans as gastrointestinal stromal tumors (GISTs). The GISTs are considered to arise from the interstitial cells of Cajal located throughout the GI tract. Positive immunohistochemical staining with CKIT antibody is a well-accepted diagnostic marker for GISTs in humans. Since there is a considerable overlap between the histomorphology of SMTs and GISTs, it is not possible to distinguish them on hematoxylin and eosin stained sections. As a result, GISTs are not routinely diagnosed in toxicological studies. The current study was designed to evaluate the tumors diagnosed as leiomyoma or leiomyosarcoma in the National Toxicology Program’s 2-year bioassays using CKIT, smooth muscle actin, and desmin immunohistochemistry. The results demonstrate that most of the mouse SMTs diagnosed as leiomyoma or leiomyosarcoma are likely GISTs, whereas in rats the tumors are likely SMTs and not GISTs.

Spindle Cell Tumor of Urinary Bladder Serosa With Phenotypic and Genotypic Features of Gastrointestinal Stromal Tumor

2000 ◽  
Vol 124 (6) ◽  
pp. 894-897 ◽  
Author(s):  
Jerzy Lasota ◽  
John A. Carlson ◽  
Markku Miettinen
Keyword(s):  
Smooth Muscle ◽  
Gastrointestinal Tract ◽  
Urinary Bladder ◽  
Smooth Muscle Actin ◽  
Molecular Genetic ◽  
S100 Protein ◽  
Pelvic Cavity ◽  
Muscle Actin ◽  
Kit Gene ◽  
Exon 11

Abstract Most mesenchymal tumors of the gastrointestinal tract are now referred to as gastrointestinal stromal tumors (GISTs). The tumors differ from ordinary leiomyomas and schwannomas in several respects: the GISTs typically express c-kit protein (CD117) and CD34, 30% to 50% of them are (often focally) positive for α-smooth muscle actin, and all are negative for desmin and S100 protein. Recently, mutations in the exon 11 of the c-kit gene have been identified and confirmed as a molecular genetic marker for the subset of GISTs. In this report, we describe a mesenchymal tumor removed from the pelvic cavity of a 52-year-old woman, who is alive without disease 36 months after the surgery. The 5-cm tumor was densely attached to the external aspect of the urinary bladder but was attached to small intestine by only filmy adhesions. The tumor grossly resembled a leiomyoma and was histologically composed of sheets of spindle cells with a dense collagenous background. The mitotic activity was low, less then 1 per 50 high-power fields. Immunohistochemically, the tumor cells were negative for α-smooth muscle actin and desmin and positive for CD117 and CD34. Molecular genetic analysis of the exon 11 of the c-kit gene revealed a point mutation in the region commonly mutated in GISTs. This mutation substituted T for A in the codon 557, leading to the change of amino acid sequence (tryptophan for arginine) of the KIT protein. This case illustrates that tumors phenotypically and genotypically similar to GISTs may present in sites other than the tubular gastrointestinal tract.

Best Practices in Diagnostic Immunohistochemistry: Pleomorphic Cutaneous Spindle Cell Tumors

2007 ◽  
Vol 131 (10) ◽  
pp. 1517-1524 ◽  
Author(s):  
Andrew L. Folpe ◽  
Kumarasen Cooper
Keyword(s):  
Differential Diagnosis ◽  
Best Practices ◽  
English Language ◽  
Spindle Cell ◽  
Smooth Muscle Actin ◽  
S100 Protein ◽  
Muscle Actin ◽  
Spindle Cell Tumors ◽  
Immunohistochemical Studies ◽  
Language Literature

Abstract Context.—Pleomorphic cutaneous spindle cell tumors can be difficult to distinguish solely on histologic grounds. The use of ancillary immunohistochemical studies can greatly assist in this differential diagnosis. Objective.—To review histologic and immunohistochemical aspects of cutaneous spindle cell tumors and discuss a basic panel of markers to assist in the differential diagnosis. Data Sources.—English-language literature published between 1981 and 2005. Conclusions.—A basic immunohistochemistry panel for high-molecular-weight cytokeratin, melanocytic markers (S100 protein, HMB-45, Melan-A), smooth muscle actin, desmin, and endothelial markers (CD31, CD34) is effective in diagnosing most cutaneous spindle cell tumors.

scholarly journals Multifocal EBV-Associated and CMV-Correlated Post-Transplant Smooth Muscle Tumor: A Case After Liver Transplantation

2021 ◽  
Author(s):  
Mohammad Hossein Anbardar ◽  
Neda Soleimani ◽  
Dornaz Safavi ◽  
Ahad Eshraghian ◽  
Abbas Ayoub
Keyword(s):  
Liver Transplantation ◽  
Smooth Muscle ◽  
Spindle Cell ◽  
Smooth Muscle Tumor ◽  
Cmv Infection ◽  
Post Transplant ◽  
Smooth Muscle Tumors ◽  
Microscopic Evaluation ◽  
Paraffin Block ◽  
Muscle Tumor

Abstract IntroductionImmunodeficient patients, including the recipients of solid organs, exhibit an increase in the incidence of neoplasms. Post-transplant smooth muscle tumor (PTSMT) is a distinct and infrequent entity of these groups of neoplasms. Epstein–Barr virus (EBV) is considered to be involved in the etiology of this neoplasm.Case reportA 28-year-old man who underwent liver transplantation presented with abdominal pain and diarrhea for several months. He had a history of resistant systemic cytomegalovirus (CMV) infection after transplantation. On physical examination, he had mild abdominal tenderness. Spiral chest and abdominopelvic CT scan with contrast showed a liver lesion with ring enhancement; furthermore, it showed a solid lesion in the spleen and multiple small lesions in lower lobes of both lungs. Colonoscopy revealed multiple small raised polypoid lesions throughout the rectum and colon. Microscopic evaluation of colon mucosa biopsy using IHC study was in favor of spindle cell neoplasm with high proliferative index. He underwent a right hemicolectomy. A microscopic study showed spindle cell proliferation with mild atypia and a mild increase in mitotic rate without any necrosis, with features of smooth muscle tumor. Trucut biopsy of liver mass was also in favor of smooth muscle tumor. According to transplantation history and considering the possibility of EBV-associated smooth muscle tumor, EBV encoded RNA (EBER) chromogenic in-situ hybridization (CISH) study on paraffin block of colon lesions was requested, which demonstrated EBV RNA in tumor cell nuclei and immunoblasts of the adjacent lymph node, suggesting EBV-associated smooth muscle tumor. In addition, PCR for CMV was requested on paraffin block of the colon lesions, which also showed a positive result. PCR for EBV and CMV viremia were negative. The dosage of immunosuppressive agents was reduced, and currently, he is being followed, with slow expansion in the size of the lesions.Conclusion Although the incidence of post-transplant smooth muscle tumors (PTSMTs) is low, it should be remained in the differential diagnosis in post-transplantation patients, especially dealing with multifocal tumors. As strong stimulant for smooth muscle tumors, close follow-up and screening for EBV and CMV infection and early treatment at the time of diagnosis are recommended to avoid these virus-induced tumors.

Epithelioid Leiomyosarcoma of the External Deep Soft Tissue

2002 ◽  
Vol 126 (4) ◽  
pp. 468-470 ◽  
Author(s):  
Tetsuji Yamamoto ◽  
Rieko Minami ◽  
Chiho Ohbayashi ◽  
Mayumi Inaba
Keyword(s):  
Soft Tissue ◽  
Tumor Cells ◽  
Epithelial Membrane Antigen ◽  
Spindle Cell ◽  
Smooth Muscle Actin ◽  
S100 Protein ◽  
Immunohistochemical Analysis ◽  
Deep Soft Tissue ◽  
Cell Component ◽  
Spindle Cell Component

Abstract Epithelioid leiomyosarcoma in the external deep soft tissue is extremely rare. Most epithelioid leiomyosarcomas occur in the uterus. We present a case of epithelioid leiomyosarcoma occurring in the muscle of the thigh of a 78-year-old man. Histologically, the tumor predominantly consisted of round or polygonal cells arranged in sheets with a focal spindle cell component. Immunohistochemical analysis revealed that the tumor cells expressed vimentin, α-smooth muscle actin, and α-sarcomeric actin. The tumor was negative for desmin, S100 protein, glial fibrillary acidic protein, pan-keratin, epithelial membrane antigen, CAM 5.2, HMB-45, leukocyte common antigen, factor VIII–associated antigen, and CD34. Electron microscopically, some tumor cells contained abundant actin-type filaments in their cytoplasm.

Interstitial Cells of Cajal in Deep Esophageal Leiomyoma

2016 ◽  
Vol 25 (1) ◽  
pp. 51-53 ◽  
Author(s):  
Magnus Hallin ◽  
Satvinder Mudan ◽  
Khin Thway
Keyword(s):  
Smooth Muscle ◽  
Interstitial Cells Of Cajal ◽  
Spindle Cell ◽  
Smooth Muscle Actin ◽  
Gastroesophageal Junction ◽  
Interstitial Cells ◽  
Correct Treatment ◽  
Mesenchymal Neoplasms ◽  
Spindle Cells ◽  
Cells Of Cajal

Gastrointestinal stromal tumors (GISTs) are potentially aggressive mesenchymal neoplasms with spindle cell, epithelioid, or mixed morphology. They typically express CD117, DOG1, and CD34 and can be diffusely and strongly positive for h-caldesmon. Leiomyomas are benign smooth muscle neoplasms that can arise in a variety of visceral and soft tissue sites, including the gastrointestinal tract. We illustrate a case of a neoplasm of the gastroesophageal junction that was clinically suspected to be a GIST. Histology showed a tumor composed of ovoid and spindle cells arranged in short intersecting fascicles, which was positive for desmin, smooth muscle actin, and h-caldesmon, with a prominent interspersed subpopulation of CD117- and DOG1-positive elongated or dendritic-like cells. These features were of leiomyoma with entrapped interstitial cells of Cajal (ICC). The recognition of possible entrapment of ICC in leiomyomas as a potential mimic of GIST is important for correct treatment and prognostication.

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