Laterally spreading features of gastrointestinal stromal tumors: A clinicopathological study

Matsukuma,Susumu; Murayama,Michinori; Utsumi,Yoshitaka; Sumi,Koji; Miyai,Kosuke; Takeo,Hiroaki

doi:10.3892/or.2018.6360

Laterally spreading features of gastrointestinal stromal tumors: A clinicopathological study

Authors:
- Susumu Matsukuma
- Michinori Murayama
- Yoshitaka Utsumi
- Koji Sumi
- Kosuke Miyai
- Hiroaki Takeo
View Affiliations

Affiliations: Department of Pathology, Japan Self‑Defense Forces Central Hospital, Setagaya‑ku, 154‑8532 Tokyo, Japan, Division of Surgery, Japan Self‑Defense Forces Central Hospital, Setagaya‑ku, 154‑8532 Tokyo, Japan
Published online on: April 10, 2018 https://doi.org/10.3892/or.2018.6360
Pages: 2681-2687

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

To elucidate the histopathological features of laterally spreading gastrointestinal stromal tumors (GISTs), we retrospectively examined 52 GISTs grossly completely resected from 50 patients. Laterally spreading features were identified in 7 GISTs (13%), and were localized within non‑thickened regions of the muscularis propria adjacent to the main GISTs, ranging in length from 0.12 to 0.7 cm (mean, 0.3 cm). The laterally spreading features involved the muscular surgical margins in 2 cases. The morphologies of the laterally spreading cells resembled those of tumor cells in 4 cases, but were comprised of more slender spindle cells with smaller nuclei compared with those in the respective main GISTs. Compared with the main GISTs, KIT+ and discovered on GIST 1+ immunostaining features of the spreading lesions were similar in 4 cases, and were weaker or diminished in the other 3 cases. There were no differences in CD34+ staining features between the main GISTs and the laterally spreading lesions. One patient with laterally spreading GIST succumbed to the disease 2.5 years after the surgery, while the other 6 patients were alive without the recurrence of disease 0.4‑19.2 years after the surgery. The laterally spreading features were associated with a pedunculated GIST (P=0.006), but not older age (P=0.312), sex (P=0.969), tumor size (P=0.430), mucosal invasion (P=0.666) or higher risk category (P=0.872). Results of the present study indicate that resection of a ≥1‑cm muscular safety margin, and not mucosa or submucosa, is required for microscopically negative surgical margins, particularly for pedunculated GISTs.

View Figures

View References

1	Miettinen M and Lasota J: Gastrointestinal stromal tumors: Pathology and prognosis at different sites. Semin Diag Pathol. 23:70–83. 2006. View Article : Google Scholar
2	Miettinen M, Fletcher CD, Kindblom LG and Tsui WM: Mesenchymal tumours of the oesophagus; mesenchymal tumours of the stomach; mesenchymal tumours of the small intestine; mesenchymal tumours of the colon and rectumWHO Classification of Tumours of The Digestive System. Bosman FT, Carneiro F, Hruban RH and Theise ND: 4th edition. International Agency for Research on Cancer; Lyon: pp. 35–36, pp74-79, pp115-116, pp181-182. 2010
3	Rosai J: Rosai and Ackerman's surgical pathology. 10th edition. Mosby/Elsevier; Philadelphia, PA: 2011, View Article : Google Scholar
4	Rubin BP: GIST and EGISTEnzinger and Weiss's soft tissue tumors. Goldblum JR, Folpe AL and Weiss SW: 6th edition. Elsevier/Saunders; Philadelphia, PA: pp. 569–590. 2014
5	Miettinen MM, Corless CL, Debiec-Rychter M, Fletcher JA, Lasota J, Rubin BP and Sciot R: Gastrointestinal stromal tumorWHO Classification of Tumours of Soft Tissue and Bone. Fletcher CDM, Bridge JA, Hogendoorn PCW and Mertens F: 4th edition. International Agency for Research on Cancer; Lyon: pp. 164–167. 2013
6	Grant NG and Noffsinger AE: Mesenchymal tumorsFenoglio-Preiser's Gastrointestinal Pathology. Noffsinger AE: 4th edition. Wolters Kluwer; Philadelphia, PA: pp. 1141–1222. 2017
7	Dematteo RP, Heinrich MC, El-Rifai WM and Demetri G: Clinical management of gastrointestinal stromal tumors: Before and after STI-571. Hum Pathol. 33:466–477. 2002. View Article : Google Scholar : PubMed/NCBI
8	Gouveia AM, Pimenta AP, Capelinha AF, de la Cruz D, Silva P and Lopes JM: Surgical margin status and prognosis of gastrointestinal stromal tumor. World J Surg. 32:2375–2382. 2008. View Article : Google Scholar : PubMed/NCBI
9	Novitsky YW, Kercher KW, Sing RF and Heniford BT: Long-term outcomes of laparoscopic resection of gastric gastrointestinal stromal tumors. Ann Surg. 243:738–747. 2006. View Article : Google Scholar : PubMed/NCBI
10	Everett M and Gutman H: Surgical management of gastrointestinal stromal tumors: Analysis of outcome with respect to surgical margins and technique. J Surg Oncol. 98:588–593. 2008. View Article : Google Scholar : PubMed/NCBI
11	Brierley JD, Gospodarowicz MK and Wittekind C: TNM classification of malignant tumours. 8th edition. Wiley-Blackwell; Hoboken: 2017
12	Joensuu H: Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 39:1411–1419. 2008. View Article : Google Scholar : PubMed/NCBI
13	Agaimy A and Wünsch PH: Sporadic Cajal cell hyperplasia is common in resection specimens for distal oesophageal carcinoma. A retrospective review of 77 consecutive surgical resection specimens. Virchows Arch. 448:288–294. 2006. View Article : Google Scholar : PubMed/NCBI
14	Espinosa I, Lee CH, Kim MK, Rouse BT, Subramanian S, Montgomery K, Varma S, Corless CL, Heinrich MC, Smith KS, et al: A novel monoclonal antibody against DOG1 is a sensitive and specific marker for gastrointestinal stromal tumors. Am J Surg Pathol. 32:210–218. 2008. View Article : Google Scholar : PubMed/NCBI
15	Miettinen M, Wang ZF and Lasota J: DOG1 antibody in the differential diagnosis of gastrointestinal stromal tumors: A study of 1840 cases. Am J Surg Pathol. 33:1401–1408. 2009. View Article : Google Scholar : PubMed/NCBI
16	Langer C, Gunawan B, Schüler P, Huber W, Füzesi L and Becker H: Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg. 90:332–339. 2003. View Article : Google Scholar : PubMed/NCBI
17	DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM and Brennan MF: Two hundred gastrointestinal stromal tumors. Recurrence patterns and prognostic factors for survival. Ann Surg. 231:51–58. 2000. View Article : Google Scholar : PubMed/NCBI
18	Zhi X, Jiang B, Yu J, Røe OD, Qin J, Ni Q, Sun L, Xu M, Zhu J and Ma L: Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: A systematic review and meta-analysis. Sci Rep. 6:215412016. View Article : Google Scholar : PubMed/NCBI
19	McCarter MD, Antonescu CR, Ballman KV, Maki RG, Pisters PWT, Demetri GD, Blanke CD, von Mehren M, Brennan MF, McCall L, et al: Microscopically positive margins for primary gastrointestinal stromal tumors: Analysis of risk factors and tumor recurrence. J Am Coll Surg. 215:53–60. 2012. View Article : Google Scholar : PubMed/NCBI