Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy - A potential pitfall

Kai Fu, Mohamad A. Eloubeidi, Nirag C. Jhala, Darshana Jhala, David C. Chhieng, Isam Eldin A. Eltoum

Research output: Contribution to journalArticle

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Abstract

Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) is considered to be a reliable and accurate method for the evaluation of submucosal lesions in the gastrointestinal tract. Herein, we report our experience with the diagnosis of 10 cases of gastrointestinal stromal tumor (GIST) using EUS-FNA. The materials obtained from the EUS-FNA were stained with the rapid Romanowsky or the Papanicolaou method for cytologic examination. The subsequent surgical resection specimens were submitted for histopathologic examination. Immunoperoxidase stains were performed on the cell blocks and/or representative histologic sections of the tumor using commercially available antibodies against c-kit (CD117), CD34, S-100, and smooth muscle actin. Of the 10 cases studied, there were five men and five women with an average age of 62 years (range, 38 to 87 years). Five tumors were located in the stomach, and five in the duodenum. Tumor size ranged from 3.5 to 16.2 cm. Immediate on-site evaluation and cytologic diagnoses were given in eight cases (80%) with an average of three passes. The diagnoses were confirmed by strong and diffuse tumor cell c-kit immunoreactivity in the cell blocks. However, the final diagnoses of two other cases (20%) were not established until surgical resections were obtained. Retrospectively, reviews of cytologic smears of both cases demonstrated rare cohesive sheets or clusters of spindle cells with cigar-shaped nuclei. These observations were initially misinterpreted as benign fibrous tissue and/or fragments of smooth muscle of the gastrointestinal wall such as one might encounter in a routine transgastric or transduodenal EUS-FNA. The current study showed that when combining cytologic and immunocytochemical studies, EUS-FNA is accurate and efficient in the diagnosis of GIST. It exemplified the importance of considering GIST in the differential diagnosis of gastrointestinal lesions and also demonstrated the potential pitfalls of EUS-FNA evaluation of submucosal lesions in the gastrointestinal tract.

Original languageEnglish (US)
Pages (from-to)294-301
Number of pages8
JournalAnnals of Diagnostic Pathology
Volume6
Issue number5
DOIs
StatePublished - Oct 2002

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Gastrointestinal Stromal Tumors
Fine Needle Biopsy
Smooth Muscle
Gastrointestinal Tract
Neoplasms
Duodenum
Tobacco Products
Actins
Stomach
Differential Diagnosis
Coloring Agents
Antibodies

Keywords

  • Cytologic diagnosis
  • Endoscopic ultrasound guided fine needle aspiration
  • Gastrointestinal stromal tumor
  • Immunocytochemistry

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy - A potential pitfall. / Fu, Kai; Eloubeidi, Mohamad A.; Jhala, Nirag C.; Jhala, Darshana; Chhieng, David C.; Eltoum, Isam Eldin A.

In: Annals of Diagnostic Pathology, Vol. 6, No. 5, 10.2002, p. 294-301.

Research output: Contribution to journalArticle

Fu, Kai ; Eloubeidi, Mohamad A. ; Jhala, Nirag C. ; Jhala, Darshana ; Chhieng, David C. ; Eltoum, Isam Eldin A. / Diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration biopsy - A potential pitfall. In: Annals of Diagnostic Pathology. 2002 ; Vol. 6, No. 5. pp. 294-301.
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