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 Table of Contents  
IMAGES AND VIDEOS
Year : 2020  |  Volume : 9  |  Issue : 6  |  Page : 413-414

Synchronous double gastric tumors: GIST or not GIST


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 Submission28-May-2020
Date of Acceptance24-Aug-2020
Date of Web Publication14-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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_61_20

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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

How to cite this URL:
Sayida S, Malkin L, Naroditski I, Assalia A, Khamaysi I. Synchronous double gastric tumors: GIST or not GIST. Endosc Ultrasound [serial online] 2020 [cited 2021 Jan 24];9:413-4. Available from: http://www.eusjournal.com/text.asp?2020/9/6/413/303355



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 Top

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.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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