背景:胃肠道间质瘤(GIST)是胃中最常见的间充质肿瘤。然而,许多其他罕见的间充质肿瘤确实发生在这个解剖部位,这通常对细胞病理学家在内窥镜超声引导下细针穿刺(EUS-FNA)的诊断提出挑战。我们的研究旨在选择性地呈现这些罕见的“非GIST”肿瘤的临床放射学和细胞病理学特征,以及他们的鉴别诊断。
方法:我们在两家大型医疗机构的细胞病理学数据库中进行了为期20年的回顾性搜索,以寻找在胃中出现并通过EUS-FNA诊断的非GIST间充质肿瘤。分析了有关患者人口统计学和放射学发现的数据。审查了所有可用的细胞病理学标本。细胞形态学特征和伴随的免疫组织化学染色,当可用时,随后进行了分析。
结果:在排除FNA诊断的所有GIST(n=113)后,有选择地将25例胃间质瘤病例纳入研究。这些病例包括10个平滑肌瘤(40%),八例神经鞘瘤(32%),五个血管球瘤(20%),一个血管周围上皮样细胞肿瘤,和一个硬纤维瘤。样本的细胞数量是可变的,范围从低细胞到高细胞。大多数涂片由梭形细胞组成,少数显示上皮样形态。在20例病例中有细胞块可用,并进行了一系列免疫组织化学辅助研究。DOG-1,C-KIT,平滑肌肌动蛋白(SMA),和S100蛋白是最常见的免疫标记。
结论:我们的研究强调了胃中罕见间充质肿瘤的重要细胞形态学特征。在适当的临床环境和免疫组织化学的帮助下,可以实现对这些肿瘤的准确诊断。
BACKGROUND: Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm arising in the stomach. However, a number of other rare mesenchymal neoplasms do occur at this anatomic site, which often presents a diagnostic challenge for cytopathologists on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Our study aims to selectively present the clinico-radiological and cytopathological characteristics of these rare \"non-GIST\" neoplasms, as well as their differential diagnoses.
METHODS: We performed a 20 year retrospective search in the cytopathology database of our two large medical institutions for non-GIST mesenchymal neoplasms arising in the stomach and diagnosed on EUS-FNA. Data regarding the patients\' demographics and radiological findings were analysed. All available cytopathology specimens were reviewed. The cytomorphological characteristics and the accompanying immunohistochemical stains, when available, were subsequently analysed.
RESULTS: Twenty-five cases of gastric mesenchymal tumours were selectively included in the study after excluding all cases of GIST (n = 113) diagnosed on FNA. These cases included 10 leiomyomas (40%), eight schwannomas (32%), five glomus tumours (20%), one perivascular epithelioid cell neoplasm, and one desmoid tumour. The specimen cellularity was variable and ranged from hypocellular to highly cellular. Most smears were composed of spindle cells with a few showing epithelioid morphology. Cell blocks were available in 20 cases and a range of immunohistochemical ancillary studies were performed. DOG-1, c-KIT, smooth muscle actin (SMA), and S100-protein were the most common immunomarkers done.
CONCLUSIONS: Our study highlights important cytomorphological characteristics of rare mesenchymal neoplasms arising in the stomach. In the appropriate clinical setting and with the help of immunohistochemistry, an accurate diagnosis of these neoplasms can be achieved.