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Kanamori K, Yamagata Y, Honma Y, Date K, Wada T, Hayashi T, Otsuki S, Sekine S, Yoshikawa T, Katai H, Nishida T. Extra-gastrointestinal stromal tumor arising in the lesser omentum with a platelet-derived growth factor receptor alpha (PDGFRA) mutation: a case report and literature review. World J Surg Oncol 2020; 18:183. [PMID: 32703220 PMCID: PMC7379776 DOI: 10.1186/s12957-020-01961-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) arising from sites other than the gastrointestinal (GI) tract, termed extra-gastrointestinal stromal tumors (EGIST), are rare. Among EGIST, those with platelet-derived growth factor receptor alpha (PDGFRA) mutations are even rarer, with only a few cases reported. About 80% of GIST has KIT mutations, and 10% of GIST have PDGFRA mutations, which commonly affect the TK2 domain (exon 18). Among the exon 18 mutations, the D842V substitution is limited to gastric GIST. In EGIST, the degree of KIT and PDGFRA mutations varies on where the location of the tumor is, and it is suggested that omental EGIST is similar to gastric GIST. Adjuvant imatinib therapy is recommended for high-risk GIST; however, it is known that imatinib is less effective against GIST with a PDGFRA D842V mutation. CASE PRESENTATION A 75-year-old man was referred to our hospital with an extrinsic tumor of the lesser curvature of the gastric body. Intraoperative findings showed a tumor located outside of the lesser omentum with no connection between the tumor and the gastric wall. The tumor was subsequently resected. Pathological examination indicated a GIST arising in the lesser omentum measuring 70 mm in its longer dimension. Because the tumor had a PDGFRA mutation (D842V substitution), imatinib was suspected to lack efficacy to the tumor. Thus, although the tumor was considered clinically to have a high risk of recurrence, adjuvant imatinib therapy was not indicated. The patient has been free of recurrence for 29 months since the surgery. CONCLUSION We described a case of EGIST with a PDGFRA mutation arising in the lesser omentum. And we reviewed 57 cases of omental EGIST and showed that the clinicopathological characteristics and mutation status in omental EGIST were very similar to gastric GIST. In particular, PDGFAR D842V mutation rate in omental EGIST seemed as high as that in gastric GIST. These results suggested that omental EGIST is strongly related to gastric GIST, so the behavior of omental EGIST might be akin to gastric GIST. However, further studies are required to determine the prognosis and the necessity of adjuvant therapy for EGIST with a PDGFRA mutation.
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Affiliation(s)
- Kohei Kanamori
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukinori Yamagata
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yoshitaka Honma
- Head and Neck Medical Oncology Division and Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Keiichi Date
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeyuki Wada
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tsutomu Hayashi
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sho Otsuki
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shigeki Sekine
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takaki Yoshikawa
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hitoshi Katai
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshiro Nishida
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Ogun GO, Adegoke OO, Rahman A, Egbo OH. Gastrointestinal Stromal Tumours (GIST): A Review of Cases from Nigeria. J Gastrointest Cancer 2019; 51:729-737. [PMID: 31659675 DOI: 10.1007/s12029-019-00318-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Gastrointestinal stromal tumours (GIST) are rare and studies on GIST in Nigeria are extremely uncommon. This study aims to achieve a comprehensive systematic review of the cases of this tumour in Nigerians. METHODS A systematic search of all available literature on GIST published from Nigeria between January 2000 and December 2018 was done and reviewed. Simple descriptive data on all the cases are presented. RESULTS The search yielded 15 publications but 13 publications with a total of 67 patients were analysed. The other two studies centred on imatinib therapy and overall survival, and molecular characteristics respectively and were therefore reviewed independently. Age at diagnosis ranged from 9 to 75 years, with mean age being in the 50s and 60s across most studies. There is no gender disparity. Anatomical location of primary tumours showed gastric location as the most frequent (61%) followed by large intestine accounting for 15%, the small intestine (9%) and other locations (15%). Tumour size ranged from 5-39.5 cm. Over 85% of patients had tumour size greater than 10 cm at presentation, hence fell into intermediate or high-risk group irrespective of location of tumour. The overall survival of a cohort of 27 patients that had imatinib therapy was 69.5% after 4 years of follow-up. KIT exon 11 mutations were the only mutations detected from a small cohort of 12 patients. CONCLUSIONS Characteristics of GIST in Nigerians are fairly similar to other parts of the world. However, most of our patients present with large masses which are of poor prognostic characteristics.
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Affiliation(s)
- Gabriel O Ogun
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Pathology, University College Hospital, Ibadan, Nigeria.
| | - Omolade O Adegoke
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Adam Rahman
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Ojevwe H Egbo
- Department of Anatomical Pathology, College of Medical Sciences, Edo University Iyamho, Iyamho, Nigeria
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Shen C, Yin Y, Chen H, Wang R, Yin X, Cai Z, Zhang B, Chen Z, Zhou Z. Secreted protein acidic and rich in cysteine-like 1 suppresses metastasis in gastric stromal tumors. BMC Gastroenterol 2018; 18:105. [PMID: 29973149 PMCID: PMC6030747 DOI: 10.1186/s12876-018-0833-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/22/2018] [Indexed: 02/05/2023] Open
Abstract
Background Malignant growth and metastasis of gastrointestinal stromal tumors (GIST) occur in some patients even during the course of treatment, but their mechanisms remains poorly understand at the molecular level so far. Methods Profiles of protein expression in gastric GIST tissues were explored using protein microarray analysis, down-regulation of SPARCL1 (secreted protein acidic and rich in cysteine-like protein 1) was validated by RT-qPCR, western blot and immunohistochemistry. The effect of specific shRNA-induced SPARCL1 downregulation on the biological traits of GIST 882 cell was investigated. We then employed a mouse xenograft model to investigate whether the low-expression of SPARCL1 impact the metastasis ability of GIST cells in vivo. Results SPARCL1 was significantly downregulated in the gastric GIST with high-grade malignance as compared with low-grade malignance, its expression was closely correlated with tumor size, mitotic index, distant metastasis at the time of initial diagnosis and tumor progression of GIST (P < 0.05). Moreover, results of the Cox analysis showed that expression of SPARCL1 is an independent prognostic predictors for gastric GIST (P = 0.008; HR 0.157, 95% CI 0.040~ 0.612). Downregulation of SPARCL1 promoted cell migration and invasion, but did not affect proliferation, cell cycle and apoptosis of GIST 882 cells. In mouse xenograft model, GIST cells with the decreased expression of SPARCL1 presented an enhanced ability of liver metastasis (P < 0.05). Conclusions Taken together, our present study demonstrated that SPARCL1 have a certain degree of malignancy-suppressing potential through inhibiting the metastasis of gastric GIST. Electronic supplementary material The online version of this article (10.1186/s12876-018-0833-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huijiao Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruixue Wang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Zhixin Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zongguang Zhou
- Institute of Digestive Surgery and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Yi JH, Park BB, Kang JH, Hwang IG, Shin DB, Sym SJ, Ahn HK, Lee SI, Lim DH, Park KW, Won YW, Lim SH, Park SH. Retrospective analysis of extra-gastrointestinal stromal tumors. World J Gastroenterol 2015; 21:1845-1850. [PMID: 25684950 PMCID: PMC4323461 DOI: 10.3748/wjg.v21.i6.1845] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/04/2014] [Accepted: 10/15/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the clinicopathologic features of patients with extra-gastrointestinal stromal tumors (EGISTs) in South Korea.
METHODS: A total of 51 patients with an EGIST were identified. The clinicopathologic features, including sex, age, location, tumor size, histology, mitotic rate, immunohistochemical features, genetic status and survival data, were analyzed.
RESULTS: The median age was 55 years (range: 29-80 years), and male:female ratio was 1:1.04. The most common site was in the mesentery (n = 15) followed by the retroperitoneum (n = 13) and omentum (n = 8). The median tumor size was 9.0 cm (range: 2.6-30.0 cm) and the median mitotic rate was 5.0/50HPF. (1/50 - 185/50). KIT was analyzed in 16, which revealed 10 cases with wild-type KIT and 6 cases with an exon 11 mutation. Among 51 patients, 31 patients had undergone surgery, and 10 had unresectable disease and had taken palliative imatinib, which resulted in 22.7 mo of progression-free survival. Of the patients who had undergone surgery, 18 did not take adjuvant imatinib, and 8 of these were categorized as “high risk” according to the risk criteria. However, the relapse-free survival was not different (P = 0.157) between two groups.
CONCLUSION: Because the biologic behaviors of GISTs differ according to the location of the tumor, a more stratified strategy is required for managing EGISTs including incorporation of molecular features.
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Yi JH, Sim J, Park BB, Lee YY, Jung WS, Jang HJ, Ha TK, Paik SS. The primary extra-gastrointestinal stromal tumor of pleura: a case report and a literature review. Jpn J Clin Oncol 2013; 43:1269-72. [PMID: 24168806 DOI: 10.1093/jjco/hyt158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The gastrointestinal stromal tumor is the most common mesenchymal neoplasm of the gastrointestinal tract. The gastrointestinal stromal tumor universally expresses KIT and DOG-1 and frequently harbors oncogenic mutations in the KIT gene. While the gastrointestinal stromal tumor usually arises in the alimentary tract, it is rarely found in the extragastrointestinal area. When it is, it is called an extragastrointestinal stromal tumor. Although the pathogenesis, prognostic factors and outcomes of gastrointestinal stromal tumors are well known, those of extragastrointestinal stromal tumors have not been fully studied. We report, herein, a unique primary extragastrointestinal stromal tumor from the pleura in a 73-year-old woman who presented with pleural mass. The extragastrointestinal stromal tumor was surgically resected and confirmed by means of an immunohistochemical study and a molecular analysis.
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Affiliation(s)
- Jun Ho Yi
- *Department of Pathology, Hanyang University Seoul Hospital, Seoul, Korea; 222 Wangsimni 2-dong, Seongdong-gu, Seoul 133-792, Korea.
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Casella C, Villanacci V, D’Adda F, Codazzi M, Salerni B. Primary Extra-gastrointestinal Stromal Tumor of Retroperitoneum. Clin Med Insights Oncol 2012; 6:189-97. [PMID: 22563251 PMCID: PMC3342024 DOI: 10.4137/cmo.s9180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. More rarely neoplasms with histology and immunohistochemistry similar to GISTs may occur outside the gastrointestinal tract ( omentum, mesentery and retroperitoneum) and are so-called Extra-gastrointestinal Stromal Tumors (EGISTs). EGISTs arising in the retroperitoneum are extremely rare: to date, only 58 cases have been reported in the literature. CASE REPORT We herein report a case of a primary EGIST of the retroperitoneum surgically treated. The pre-operative radiological evaluation showed a retroperitoneal mass, placed in left paravertebral region. RESULTS Morphological and immunohistochemical features led to a diagnosis of extra-gastrointestinal stromal tumor (intermediate-low risk form). CONCLUSIONS As a result of the rarity of reports of primary EGISTs of retroperitoneum we need to analyze the data of reported cases in order to gain a better understanding about the pathogenesis, prognosis and optimal treatment of this disease.
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Affiliation(s)
- Claudio Casella
- Department of Medical and Surgical Sciences, University of Brescia, 1st Division of General Surgery—Spedali Civili Brescia, Brescia, Italy
| | | | - Filippo D’Adda
- Department of Medical and Surgical Sciences, University of Brescia, 1st Division of General Surgery—Spedali Civili Brescia, Brescia, Italy
| | - Manuela Codazzi
- Department of Medical and Surgical Sciences, University of Brescia, 1st Division of General Surgery—Spedali Civili Brescia, Brescia, Italy
| | - Bruno Salerni
- Department of Medical and Surgical Sciences, University of Brescia, 1st Division of General Surgery—Spedali Civili Brescia, Brescia, Italy
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Hinescu ME, Popescu LM, Gherghiceanu M, Faussone-Pellegrini MS. Interstitial Cajal-like cells in rat mesentery: an ultrastructural and immunohistochemical approach. J Cell Mol Med 2007; 12:260-70. [PMID: 18194443 PMCID: PMC3823487 DOI: 10.1111/j.1582-4934.2008.00226.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Interstitial Cajal-like Cells (ICLC) were recently recognized in a plethora of non-digestive organs. Here, we describe a cell type of rat mesentery sharing ultrastructural and immunohistochemical features with ICLC. Mesenteric ICLC were demonstrated by transmission electron microscopy (TEM) and further tested by light microscope immunohistochemistry. The cell described here fulfils the TEM diagnostic criteria accepted for ICLC: location in the connective interstitium; close vicinity to nerves, capillaries and other interstitial cells; characteristic long, moniliform cell processes; specialized cell-to-cell junctions; caveolae; mitochondria at 5–10% of cytoplasmic volume; rough endoplasmic reticulum at about 1–2%; intermediate and thin filaments, microtubules; undetectable thick filaments. The processes of this mesenteric ICLC were particularly long, with a mean length of 24.91 μm (10.27–50.83 μm), and a convolution index of 2.32 (1.37–3.63) was calculated in order to measure their potential length. Mean distances versus main target cells of ICLC–nerve bundles, vessels, adipocytes and macrophages–were 110.69, 115.80, 205.07 and 34.65 nm, respectively. We also tested the expression of CD117/c-kit, CD34, vimentin, α-smooth muscle actin, nestin, NK-1, tryptase and chymase and the antigenic profile of the mesenteric ICLC was comparable if not identical with that recently observed in ICLC from other extra-digestive tissues. Due to the peculiar aspect of the mesenteric ICLC processes it can be hypothesized that these cells form a three-dimensional network within the mesentery that is at the same time resistant and deformable following stretches consequent to intestine movements, mainly avoiding blood vessels closure or controlling blood vessels rheology. It remains, however, to be established if and how such cells are connected with the archetypal enteric ICC.
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Affiliation(s)
- M E Hinescu
- Victor BabesNational Institute of Pathology, Bucharest, Romania
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Wu AW, Gu J, Li JY, Liu JX, Sun Y, Zhou LX. Gastrointestinal stromal tumors of the anorectum — A special entity: GISTs of the anorectum. Chin J Cancer Res 2006. [DOI: 10.1007/s11670-006-0038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Goerres GW, Stupp R, Barghouth G, Hany TF, Pestalozzi B, Dizendorf E, Schnyder P, Luthi F, von Schulthess GK, Leyvraz S. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2004; 32:153-62. [PMID: 15690223 PMCID: PMC2706372 DOI: 10.1007/s00259-004-1633-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 06/16/2004] [Indexed: 12/14/2022]
Abstract
Purpose Gastrointestinal stromal tumours (GIST) are mesenchymal neoplasms of the gastrointestinal tract that are unresponsive to standard sarcoma chemotherapy. Imaging of GIST patients is done with structural and functional methods such as contrast-enhanced helical computed tomography (ceCT) and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG). The aim of this study was to compare the prognostic power of PET and ceCT and to evaluate the clinical role of PET/CT imaging. Methods All patients with GIST undergoing PET or PET/CT examinations were prospectively included in this study, and the median overall survival, time to progression and treatment duration were documented. The prognostic significance of PET and ceCT criteria of treatment response was assessed and PET/CT was compared with PET and ceCT imaging. Data for 34 patients (19 male, 15 female, 21–76 years) undergoing PET or PET/CT for staging or restaging were analysed. Results In 28 patients, PET/CT and ceCT were available after introduction of treatment with the tyrosine kinase inhibitor imatinib mesylate (Gleevec; Novartis, Basel, Switzerland). Patients without FDG uptake after the start of treatment had a better prognosis than patients with residual activity. In contrast, ceCT criteria provided insufficient prognostic power. However, more lesions were found on ceCT images than on PET images, and FDG uptake was sometimes very variable. PET/CT delineated active lesions better than did the combination of PET and ceCT imaging. Conclusion Both PET and PET/CT provide important prognostic information and have an impact on clinical decision-making in GIST patients. PET/CT precisely delineates lesions and thus allows for the correct planning of surgical interventions.
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Affiliation(s)
- G W Goerres
- Division of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Abstract
We report the case of a malignant, primary, hepatic gastrointestinal stromal tumor (GIST) that was resected from the liver of a 79-year-old woman. To our knowledge, this is the first primary, hepatic GIST on record. The tumor expressed CD117 (c-Kit protein) and vimentin and had the ultrastructural features of GISTs. Sixteen months after partial hepatectomy and resection of the tumor, a hilar lymph node metastasis was found. The metastatic tumor had the same morphologic features as the primary tumor, but in addition it contained numerous multinucleated giant cells. This case shows that GIST can occur as a primary liver tumor, and accordingly, we point out that not all hepatic tumors with a GIST phenotype should be automatically considered to be metastases from a primary gastrointestinal site.
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Affiliation(s)
- Xuejiao Hu
- Department of Pathology, The University of Kansas School of Medicine, Kansas City, Kan 66160-7410, USA
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Rumessen JJ, Vanderwinden JM. Interstitial Cells in the Musculature of the Gastrointestinal Tract: Cajal and Beyond. ACTA ACUST UNITED AC 2003; 229:115-208. [PMID: 14669956 DOI: 10.1016/s0074-7696(03)29004-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Expression of the receptor tyrosine kinase KIT on cells referred to as interstitial cells of Cajal (ICC) has been instrumental during the past decade in the tremendous interest in cells in the interstitium of the smooth muscle layers of the digestive tract. ICC generate the pacemaker component (electrical slow waves of depolarization) of the smooth musculature and are involved in neurotransmission. By integration of ICC functions, substantial progress has been made in our understanding of the neuromuscular control of gastrointestinal motility, opening novel therapeutic perspectives. In this article, the ultrastructure and light microscopic morphology, as well as the functions and the development of ICC and of neighboring fibroblast-like cells (FLC), are critically reviewed. Directions for future research are considered and a unifying concept of mesenchymal cells, either KIT positive (the "ICC") or KIT negative "non-Cajal" (including the FLC and possibly also other cell types) cell types in the interstitium of the smooth musculature of the gastrointestinal tract, is proposed. Furthermore, evidence is accumulating to suggest that, as postulated by Santiago Ramon y Cajal, the concept of interstitial cells is not likely to be restricted to the gastrointestinal musculature.
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Affiliation(s)
- Jüri J Rumessen
- Department of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
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