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Mohamed N, Khan M, Hosler G, Tumminello K. Primary vulvar extragastrointestinal stromal tumor in a 77-year-old woman. J Cutan Pathol 2023. [PMID: 37127848 DOI: 10.1111/cup.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
Extragastrointestinal stromal tumors (EGISTs) carry the same morphological, immunohistochemical and molecular features as gastrointestinal stromal tumors (GISTs) and involve extragastrointestinal tract soft tissue. The majority of reported EGIST cases arise from intraabdominal, retroperitoneal, or pelvic soft tissue. A significant subset of such tumors originates from the gastrointestinal muscle layer, grows in an exophytic manner, then loses attachment to the gastrointestinal tract. Consequently, true EGISTs are exceedingly rare. Herein, we are reporting a case of a vulvar EGIST. A 77-year-old woman presented with a painless subcutaneous nodule on the right perineum. An excisional biopsy showed a fairly circumscribed bland spindle cell lesion in the dermis. The tumor cells were positive for CD117 and ANO1/DOG-1 and negative for smooth muscle myosin, smooth muscle actin, STAT6, low- and high-molecular-weight cytokeratins, SOX10, MART-1, CD10, S-100 protein, and estrogen and progesterone receptors. A diagnosis of EGIST was made and complete excision was recommended. Superficial/subcutaneous EGISTs are extremely rare, and it is important for dermatopathologists to be aware of this entity as it can be misdiagnosed as more common spindle cell neoplasms, both benign and malignant, including but not limited to smooth muscle neoplasms (leiomyoma/leiomyosarcoma), spindle cell melanoma, and sarcomatoid squamous cell carcinoma.
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Affiliation(s)
- Nada Mohamed
- Department of Pathology, Texas A&M College of Medicine-Baylor Scott & White Health, Temple, Texas, USA
| | | | - Gregory Hosler
- ProPath, Dallas, Texas, USA
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
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Addley S, Alazzam M, Johnson C, Soleymani Majd H. Rectovaginal extragastrointestinal stromal tumour (EGIST): an additional entity to be considered in the differential diagnosis of tumours of the rectovaginal septum. BMJ Case Rep 2021; 14:14/3/e237669. [PMID: 33685909 PMCID: PMC7942270 DOI: 10.1136/bcr-2020-237669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are rare - and rectovaginal extragastrointestinal stromal tumours (RV-EGISTs) even rarer. We share a case of RV-EGIST, complemented by high-quality radiological and surgical images. A review of current literature pertaining to RV-EGIST is also included. Our case report highlights the diagnostic challenge presented by extragastrointestinal stromal tumours. Differentiated from overlapping pathologies only by targeted application of immunohistopathology and cytogenetics, the inclusion of RV-EGIST in the differential diagnosis of a rectovaginal tumour is essential to making this correct diagnosis. Primary surgery is the treatment of choice for RV-EGIST if complete cytoreduction can be achieved, combined with adjuvant tyrosine kinase inhibitor (TKI) therapy for those with high-risk features to further reduce rates of future recurrence.
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Affiliation(s)
- Susan Addley
- Department of Gynaecology Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Moiad Alazzam
- Department of Gynaecology Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Catherine Johnson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Hooman Soleymani Majd
- Department of Gynaecology Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Cheng M, Liu CH, Horng HC, Chen YJ, Lo PF, Lee WL, Wang PH. Gastrointestinal stromal tumor presenting as a rectovaginal septal mass: A case report and review of literature. Medicine (Baltimore) 2019; 98:e15398. [PMID: 31027138 PMCID: PMC6831160 DOI: 10.1097/md.0000000000015398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) arising from the gynecological tract are extremely rare. A case of GIST with an unusual presentation as a vaginal mass is presented with comprehensive literature review, aiming to gain a better understanding of the diagnostic and treatment strategy of the disease. PATIENT CONCERNS A 78-year-old woman presented with persistent vaginal bleeding and difficulty in micturition. Although the tumor mass was diagnosed, the results of preoperative evaluations are uncertain. DIAGNOSIS Preoperative evaluation included the computed tomography examination (a 6.3×5.3 cm cervical mass lesion with rectal and vaginal invasion), colonoscopy (an external compression with an intact mucosa), tumor markers, and biopsy (spindle cell tumor). Postoperative histopathology confirmed the diagnosis of GIST. INTERVENTIONS Posterior exenteration with complete resection was performed. The patient received postoperative adjuvant imatinib therapy. OUTCOMES The patient has survived without the disease for more than 3 years. CONCLUSION It is still a challenge to diagnose GISTs in women with rectovaginal mass preoperatively. Efforts should be made, including a high suspicion and an assistance of immunohistochemistry. A precise diagnosis may offer a better surgical and treatment plan, especially on the preservation of reproductive organs and accessibility of targeted therapy.
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Affiliation(s)
- Min Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pei-Fen Lo
- Department of Nursing, Taipei Veterans General Hospital
| | - Wen-Ling Lee
- Department of Nursing, Oriental Institute of Technology, New Taipei City
- Department of Medicine, Cheng-Hsin General Hospital
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital
- Department of Obstetrics and Gynecology, National Yang-Ming University
- Institute of Clinical Medicine, National Yang-Ming University
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Kosemehmetoglu K, Kaygusuz G, Fritchie K, Aydin O, Yapicier O, Coskun O, Karatayli E, Boyacigil S, Guler G, Dervisoglu S, Kuzu I. Clinical and pathological characteristics of gastrointestinal stromal tumor (GIST) metastatic to bone. Virchows Arch 2017; 471:77-90. [PMID: 28488171 DOI: 10.1007/s00428-017-2138-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/11/2017] [Accepted: 04/26/2017] [Indexed: 12/16/2022]
Abstract
Our aim in this study was to describe the clinical, morphological, and molecular profile of gastrointestinal stromal tumor (GIST) metastatic to bone. We analyzed the morphological, phenotypic, and molecular characteristics of seven cases, and in addition reviewed 17 cases from literature. Sequence analysis of KIT and PDGFRA genes was possible for six cases. For the GIST cases with bone metastasis, the most common primaries were small intestine (29%), stomach (25%), and rectum (21%). Sites of bone metastases were vertebrae (11), pelvis (8), femur (8), ribs (6), humerus (5), skull (3), scapula (1), and mandible (1). The size ranged from 1.5 to 13 cm (median, 3.8 cm). Bone metastases without involvement of any other organ were seen in 17% of the cases and were solitary in 14 (58%). Adjacent soft tissue involvement was present in nearly half of the patients. Bone metastasis was either manifest at the time of diagnosis (28%) or occurred after a mean period of 4.7 years (3 months-20 years). Morphologically, neoplastic cells were spindle in 67%, epithelioid in 13%, and mixed epithelioid and spindle in 20%. CD117, DOG1, and CD34 were positive in 88, 86, and 85% of the cases, respectively. KIT Exon 11 mutations were the most frequent gene alteration (78%), followed by KIT Exon 13 mutations. Of 17 of the cases with available follow-up information, 7 (41%) patients developed bone metastasis under imatinib therapy. Five patients (29%) died of disease within a mean of 17 months. Bone metastases from GIST are usually found in patients with advanced disease and typically present as lytic masses with occasional soft tissue involvement. We could not identify any KIT or PDGFRA alterations predisposing to bone metastasis.
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Affiliation(s)
- Kemal Kosemehmetoglu
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Gulsah Kaygusuz
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Karen Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ovgu Aydin
- Department of Pathology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ozlem Yapicier
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Oznur Coskun
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Senay Boyacigil
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Sergulen Dervisoglu
- Department of Pathology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Isinsu Kuzu
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
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Affiliation(s)
- Debra S. Heller
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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Abstract
OBJECTIVE To describe a rare case of gastrointestinal stromal tumor (GIST) outside the gastrointestinal tract and arising in the rectovaginal septum with literature review. CASE This study involved a 29-year-old woman, gravida 0, with a GIST presenting as an asymptomatic tumor in the rectovaginal septum. The tumor was excised locally, and the patient received imatinib as adjuvant therapy. She is free of disease 2 years after surgery. CONCLUSIONS To our knowledge, only 5 cases of GIST presenting as rectovaginal mass have been reported previously. Local excision is the definitive treatment and the use of imatinib shows promising results. Mitotic activity, cellularity, and necrosis are the main prognostic factors. Long-term follow-up is necessary.Different physicians involved in the evaluation of a mass arising in the rectovaginal septum should be alert of GIST as differential diagnosis, even in young women.
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Abstract
Since Mazur and Clark first proposed the term gastrointestinal stromal tumors (GIST) in 1983, GIST have become a hot topic of pathological and clinical research. Stromal tumors that occur outside the gastrointestinal tract (EGIST) are relatively rare. Imaging technology plays an important role in the diagnosis of EGIST. In this article, we will review the advances in imaging diagnosis of EGIST.
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