1/72. A case report of gastric carcinosarcoma with rhabdomyosarcomatous and neuroendocrinal differentiation.We report herein an unusual gastric carcinosarcoma with rhabdomyosarcomatous and neuroendocrinal differentiation in a 63-year-old Japanese male. The tumor was a pedunculated large polypoid tumor (7 x 6.5 x 3.5 cm) located in the pylorus. Histologically, it invaded to the subserosa and was composed of both adenocarcinomatous and sarcomatous components. Adenocarcinomatous foci generally showed tubular to solid patterns and occupied the parts facing the gastric lumen, while the sarcomatous components showed a generally irregular and solid arrangement. There were transitions between the sarcomatous and carcinoma elements. In addition, carcinoma cells with a cord-like or trabecular arrangement similar to that seen in endocrine carcinoma expressed chromogranin a, and were mainly observed in an intermediate area between the adenocarcinomatous and sarcomatous foci. The sarcomatous areas were mainly composed of spindle cells and occasionally contained a sarcomatous component showing rhabdomyosarcomatous differentiation. This is an interesting case to consider how the variety of cell type appeared in such a type of tumor in the stomach.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
2/72. hemoperitoneum due to a ruptured gastric stromal tumor.BACKGROUND/AIMS: gastrointestinal stromal tumors form a group of uncommon neoplasms originated from pluripotential mesenchymal cells. Many patients are asymptomatic and the tumor is discovered during an abdominal operation. Massive intraperitoneal bleeding is an exceptional complication associated with high mortality rates. Our aim is to report a case of a gastric stromal tumor in an 83-year-old patient presenting with intraperitoneal hemorrhage and hypovolemic shock, successfully operated. methods: Emergency laparotomy showed a hemoperitoneum caused by rupture of a large exogastric tumor attached to the greater curvature. Total gastrectomy and esophagojejunostomy was performed. RESULTS: Histological examination revealed proliferation of spindle-shaped cells but immunocytochemistry failed to identify specific markers of smooth muscle and neural cells. diagnosis of a gastric stromal tumor was made. Postoperative evolution was uncomplicated. CONCLUSION: Gastric stromal tumor is a relatively rare neoplasm of mesenchymal origin whose nature and prognosis is unclear.- - - - - - - - - - ranking = 0.28967598245073keywords = spindle (Clic here for more details about this article) |
3/72. Synovial sarcoma of the upper digestive tract: a report of two cases with demonstration of the X;18 translocation by fluorescence in situ hybridization.Two cases of synovial sarcoma that arose in the upper digestive tract are reported. One case was a polypoid mass that arose at the gastroesophageal junction; the other was a large intramural mass that arose in the wall of the stomach. Both cases had a classic biphasic pattern. In the stomach tumor, the biphasic morphology was focal and there was an abrupt transition to poorly differentiated synovial sarcoma. The tumors had immunohistochemical features that were consistent with synovial sarcoma. Ultrastructural evaluation of the gastroesophageal tumor supported the diagnosis. The diagnostic X;18 translocation was demonstrated by fluorescence in situ hybridization on sections from paraffin-embedded tissue in 86% and 50% of interphase nuclei from the gastroesophageal and gastric tumor, respectively. The translocation was present in equal frequency in the epithelial and spindle cells in the biphasic areas and the poorly differentiated areas of the gastric tumor, indicating that the development of the more aggressive subclone was probably due to genetic mutations not encompassing the SYT-SSX gene fusion product. We are aware of only five reported cases of synovial sarcoma arising in the digestive tract, all in the proximal esophagus. These cases are the first reported arising in the gastroesophageal junction and stomach and the only cases of synovial sarcoma of the digestive tract in which the diagnostic translocation was demonstrated. Sarcomatoid carcinoma (carcinosarcoma) and gastrointestinal stromal tumor are the main differential diagnoses for synovial sarcoma in this site. Synovial sarcoma of the digestive tract may be underdiagnosed, and its recognition may have important clinical implications. fluorescence in situ hybridization is helpful in making this distinction.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
4/72. Simultaneous transhiatal esophagectomy and coronary artery bypass grafting without cardiopulmonary bypass.A 69-year-old patient underwent simultaneous transhiatal esophagectomy for carcinoma of the esophagogastric junction and benign spindle cell gastric tumor and coronary artery bypass grafting without cardiopulmonary bypass. A standard technique of transhiatal esophagectomy was used. The long saphenous vein was grafted to the left anterior descending artery and to the distal circumflex artery. The total theatre time was 6.5 h and the total ischemic time was 19 min. The patient made a good recovery and was discharged on day 18. He is enjoying an active lifestyle 6 months post-operatively.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
5/72. A case of gastrointestinal stromal tumor of the stomach.In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis c discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
6/72. Cytomorphology of gastrointestinal stromal tumor: diagnostic role of aspiration cytology, core biopsy, and immunochemistry.gastrointestinal stromal tumors (GISTs) comprise a heterogeneous group of neoplasms of the gastrointestinal tract previously referred to as leiomyomas, leiomyosarcomas, or schwannomas. GISTs derive from the interstitial cell of Cajal and, in addition to variable expression of smooth muscle and neural markers, they characteristically express CD34 and CD117. To our knowledge, the cytologic appearance of gastric neoplasms designated as GISTs has never been reported. We illustrate the fine-needle aspiration (FNA) cytology findings of a gastric stromal tumor having spindle cells with delicate cytoplasm and prominent nuclear palisading. Consistent core biopsy and immunochemistry findings further supported the diagnosis of GIST. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. In the appropriate clinical and radiologic setting, a confident diagnosis of GIST can be established by FNA cytology and core biopsy. The roles of immunochemical stains and other ancillary techniques in reaching the correct diagnosis are addressed.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
7/72. Follicular dendritic cell sarcoma presenting as a submucosal tumor of the stomach.Follicular dendritic cell (FDC) sarcomas, especially those of extranodal origin, are extremely rare, and this entity could easily be missed without a high index of suspicion. We report a case of FDC sarcoma presenting as a submucosal tumor of the stomach in a 45-year-old man. The mass was a spindle and epithelioid mesenchymal tumor with many individually scattered and perivascular aggregates of lymphocytes. Immunohistochemical and ultrastructural studies confirmed the diagnosis. Although more than 50 cases of this tumor have been documented in the English literature, to our knowledge the presentation of FDC sarcoma as a submucosal tumor of the stomach has never been recorded. This case highlights the occurrence of FDC sarcoma as a submucosal tumor of the gastrointestinal tract. We believe that FDC sarcoma should be included in the differential diagnosis of spindle or epithelioid cell tumors of the gastrointestinal hollow viscus to prevent this still under-recognized tumor from being overlooked.- - - - - - - - - - ranking = 0.57935196490145keywords = spindle (Clic here for more details about this article) |
8/72. Gastrointestinal stromal tumor of the stomach: report of a case.We report herein the case of a 70-year-old woman found to have a gastrointestinal stromal tumor (GIST) of the stomach. Preoperative X-ray and endoscopic examination revealed a hemispheric submucosal tumor with central depression in the anterior wall of the gastric fornix. The tumor, which was 3 cm in diameter, was resected by a laparoscopy-assisted procedure. Histologic examination revealed that it was composed of spindle-shaped cells with elongated nuclei, and few mitoses. Most of the tumor cells showed immunoreactivity for vimentin and CD34, but not for alpha-smooth muscle actin, desmin, or S-100 protein. The PCNA index was 40.5%. Thus, the GIST did not show differentiation toward smooth muscle or neural cells. A gastrectomy was not performed because the small size of the tumor, and the paucity of the mitoses indicated that it was benign. Nevertheless, careful and long-term follow-up is needed to monitor for signs of possible local recurrence or distant metastases.- - - - - - - - - - ranking = 0.28967598245073keywords = spindle (Clic here for more details about this article) |
9/72. Uncommitted gastrointestinal stromal tumour. Case report.Gastrointestinal Stromal Tumours (GIST) are mesenchymal tumours with uncertain prognosis. Malignant variety represents about 2.0% of malignant gastroenteric tumours. The Authors report a clinical case of malignant gastric and duodenojejunal GIST, in which the only surgical treatment seems to be definitive. R. S., a 69-year-old female, was admitted for asthenia and fever in January 1997. Endoscopic exploration, ultrasonography and CT-scan of the abdomen demonstrated an exophytic tumour in the greater gastric curvature and one tumour of 5.5 cm of diameter in the Treitz's angle. We performed a resection of the gastric tumour and the duodenojejunal angle. Postoperative course was uneventful and the patient was discharged after 14 postoperative hospital days. Histological analysis showed two spindle cells stromal tumours with mitotic rate > 20/10 HPF. The immunohistochemistry demonstrated the uncommitted origin of tumour cells. The patient refused the chemotherapy treatment. There was no local recurrence or metastasis at a follow up of 47 months, in spite the high malignancy degree. For this reason and because of the uncertain behaviour of benign GIST, the authors propose a lifelong follow up of the patients managed with potentially curative surgical resection.- - - - - - - - - - ranking = 1keywords = spindle cell, spindle (Clic here for more details about this article) |
10/72. Gastrointestinal stromal tumor of the stomach diagnosed preoperatively.A case of gastrointestinal stromal tumor (GIST) of the stomach is reported. GIST has been applied to gastrointestinal submucosal tumors mainly composed of spindle shaped cells that represent neither typical features of myogenic nor neurogenic tumors, and immunohistochemical studies are necessary for the diagnosis of GIST. The patient was a 39-year-old man and was successfully diagnosed to be GIST (uncommitted type) preoperatively by immunohistochemical studies of biopsy specimens from an ulcerative submucosal tumor with bridging folds in the fundus, approximately 3.0 cm in size. Local excision of the stomach was performed. This is the 3rd case of GIST with a preoperative diagnosis to appear in the literature in japan. For gastroenterological surgeons, it is critical to select the most suitable surgical procedure. In the present, because the number of papers reporting GIST of the stomach is small, it is impossible to review GIST clinicopathologically. We reviewed the surgical procedure for gastric leiomyosarcomas, because of including many cases with GIST in them. Therefore, we performed 54 cases of gastric GIST in the literature, compared with 92 cases of gastric leiomyosarcoma. As a result, it was thought that local excision for gastric GIST should be preferred.- - - - - - - - - - ranking = 0.28967598245073keywords = spindle (Clic here for more details about this article) |
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