Clinical history: A 53-year-old lady presented with 3-month history of dysphagia. A CT scan of her thorax revealed a submucosal mass at the gastro-oesophageal junction. Endoscopic ultrasound-guided fine needle aspirate obtained the following smear.
Three differentials to consider: GIST, Smooth muscle tumour (Leiomyoma), Schwannoma
Similarities include:
- Fascicular arrangement
- Spindle cells
- Uniform nuclei
|
GIST |
Leiomyoma |
Schwannoma |
|
|
Cellularity |
Intermediate to high |
Low to intermediate |
Low to intermediate |
|
Background |
Clean, occasional naked nuclei |
Clean |
Lymphoid-rich, especially in the GIT |
|
Nuclear atypia |
Minimal |
Minimal |
Focal to minimal (ancient change) |
|
Nucleus |
Elongated with blunt ends |
Elongated with blunt ends |
Elongated with pointed ends |
|
Cytoplasm |
Scant, fibrillary |
Moderate amounts |
Scant, fibrillary |
|
GIST |
Leiomyoma |
Schwannoma |
|
|
CD117 (C-Kit) |
+ |
- |
- |
|
DOG1 |
+ |
- |
- |
|
CD34 |
+ |
- |
- |
|
SMA, desmin |
- |
+ |
- |
|
S100 |
- |
- |
+ |
Gastrointestinal stromal tumour
Case writer: Dr Noel Chia
