Gastrointestinal stromal tumor (GIST) - gastric (pathology)

Case contributed by Andrew Ryan

Presentation

Abdominal pain for investigation. Incidental finding on gastroscopy - now resection.

Patient Data

Age: 55 years
Gender: Male

Macro (distal gastrectomy specimen): There is a solid and partly cystic/hemorrhagic lesion in the gastric wall, with intact and relatively normal overlying gastric mucosa. The lesion extends to but does not appear to breach the serosa.

Microscopic features;

  • 'spindle cell' pattern
  • cells arranged in whorls and irregular fascicles
  • cells have spindled to elongate nuclei (these tumors can be 'epithelioid')
  • positive staining for c-Kit
  • important microscopic prognostic features include;
    • low mitotic activity (we give a count of number of mitoses/50 high power fields [x400])
    • no necrosis
    • uniform low cellularity
    • minimal pleomorphism

Case Discussion

The important prognostic features in this case include; 

  • location (gastric)
  • size (55mm)
  • mitotic activity (up to 2 per 50 hpf)

Using published data (see reference below), this case has a 'low' risk of progessive disease. 

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