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| IMAGES AND VIDEOS |
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| Year : 2020 | Volume
: 9
| Issue : 6 | Page : 413-414 |
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Synchronous double gastric tumors: GIST or not GIST
Sa'd Sayida1, Leonid Malkin2, Inna Naroditski2, Ahmad Assalia3, Iyad Khamaysi4
1 Department of Surgery, Rambam Health Care Campus, Haifa, Israel
2 Department of Cytopathology, Rambam Health Care Campus, Haifa, Israel
3 Department of Surgery, Rambam Health Care Campus; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Technion, Haifa, Israel
4 The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Technion; Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel
| Date of Submission | 28-May-2020 |
| Date of Acceptance | 24-Aug-2020 |
| Date of Web Publication | 14-Dec-2020 |
Correspondence Address:
Iyad Khamaysi
Department of Gastroenterology and Hepatology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 9602, Haifa 31096
Israel
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/eus.eus_61_20
How to cite this article:
Sayida S, Malkin L, Naroditski I, Assalia A, Khamaysi I. Synchronous double gastric tumors: GIST or not GIST. Endosc Ultrasound 2020;9:413-4 |
A 41-year-old healthy woman was referred for an upper endoscopy due to epigastric pain. The gastric mucosa was normal but an external pressure on lesser gastric curvature was suspected. Computed tomography and magnetic resonance imaging showed two separated exophytic heavily calcified masses (3.2, 3.8 cm) connected to the lesser gastric curvature wall. Due to the densely calcified texture of the tumors [Figure 1]a, they were almost invisible by endoscopic ultrasound (wide acoustic shadowing) [Figure 1]b. A 22-gauge biopsy needle (Medi-Globe GmbH; GERMANY) could hardly penetrate the tumor. Histologic examination of the FNB specimen showed fibrotic tissue with calcification [Figure 1]c, positive for CD34 but negative for CD117, DOG1, Desmin and SOX10. With this uncertain nature of the tumors (gastrointestinal stromal tumor [GIST] vs. other soft-tissue tumors), the patient underwent partial gastrectomy [Figure 2]a. Pathological examination [Figure 2]b revealed 2 gastric tumors composed of bland-looking spindle cells, hyalinized fibrous stroma, foci of lymphoplasmacytic inflammation with lymphoid follicles formation and prominent calcifications. The tumor cells are positive for Vimentin, focally positive for CD34 and negative for Actin, ALK1, CD117, DOG1, STAT6, and S-100. The findings were diagnostic for benign calcifying fibrous tumor (CFT) of the stomach. | Figure 1: (a) CT image showing 2 gastric tumors. (b) EUS image showing calcified gastric tumor. (c) Histologic examination of the FNB specimen showing fibrotic tissue with calcification, positive for CD34
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 | Figure 2: (a) Partial gastrectomy showing 2 gastric tumors. (b) Pathological examination showing gastric tumors composed of bland-looking spindle cells, hyalinized fibrous stroma, foci of lymphoplasmacytic inflammation with lymphoid follicles formation and prominent calcifications
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CFT is a very rare begin fibroblastic tumor with histopathological profile mimicking various spindle cell tumors. The tumor is benign and characterized by a grossly well-demarcated, unencapsulated, lobulated mass with a white cut surface. Microscopically, CFT was identified by the tumor's paucicellular trait and it is containing hyalinized collagen with interspersed dystrophic or psammomatous calcification, and infiltrating inflammatory cells composed of lymphocytes and plasma cells.[1]
For diagnosis, CFT must be differentiated from various other types of tumors. The most important differential diagnoses in intra-abdominal CFT are GIST, leiomyoma, inflammatory myofibroblastic tumor, solitary fibrous tumor, and IgG4-related disease. Due to their heterogeneous symptoms, these tumors are diagnosed based on imaging and pathologic findings, including immunohistochemical staining.[2]
Currently, complete surgical resection is the treatment of choice with excellent prognosis.[3]
Awareness of the clinicopathologic characteristics of this rare entity and its mimickers contribute to avoiding misdiagnosis and mistreatment in clinical practice.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her names and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Voth E, Serio S, Gross J, et al. Solitary fibrous tumor of the stomach with high-grade sarcomatous dedifferentiation. J Surg Case Rep 2018;2018:rjy307.  |
| 2. | Kwan BS, Cho DH. Calcifying fibrous tumor originating from the gastrohepatic ligament that mimicked a gastric submucosal tumor: A case report. World J Clin Cases 2019;7:2802-7. |
| 3. | Zhou J, Zhou L, Wu S, et al. Clinicopathologic study of calcifying fibrous tumor emphasizing different anatomical distribution and favorable prognosis. Biomed Res Int 2019;2019:5026860. |
[Figure 1], [Figure 2]
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