Gastrointestinal stromal tumours of the stomach: Cytological and immunocytochemical diagnostic features of two cases diagnosed by endoscopic ultrasound-guided fine needle aspiration

Abstract

The present study reports the diagnostic utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNAC) in two patients affected by gastrointestinal stromal tumours (GISTs) of the stomach. Clinically, the patients demonstrated skin pallor, melena, gastric discomfort and pain that had lasted three days or weeks. The cytological findings are discussed; these were strongly supported by immunocytochemical procedures that were performed on cell blocks and further confirmed following post-surgical histopathological examination. The crucial aim of GIST management is to determine a correct diagnosis in early-phase disease in order to realize an adequate curative surgical resection before the tumour becomes unresectable or metastatic. Moreover, a correct pre-surgical differential diagnosis of GISTs from other mesenchymal neoplasms may be easily made by EUS-FNAC, supported by cytological and immunocytochemical features.

Gastrointestinal Stromal Tumors in the 21<sup>st</sup> Century

“…However, EUS-FNA fails to yield an adequate tissue sample in up to one-third of specimens [39]. Factors that affect the diagnostic yield include: site, size and characteristics of the tissue; technical and procedural factors; endosonographer and cytopathologist expertise [52]. Larger tumors have a higher diagnostic accuracy, with reported rates for tumours of 2 cm, 2 -4 cm, and 4+ cm at 71%, 86%, and 100% respectively [53].…”

“…Larger tumors have a higher diagnostic accuracy, with reported rates for tumours of 2 cm, 2 -4 cm, and 4+ cm at 71%, 86%, and 100% respectively [53]. A similar procedure, endoscopic ultrasound-guided tru-cut biopsy (EUS-TCB) which uses a stiffer device, has additionally been described as rapid and safe; however, no standards for its use have been determined [52].…”

“…Cytopathological findings obtained in FNA specimens suggestive of a GIST may include spindle shaped cells with scant cytoplasm and elongated-to-oval nuclei [52]. Cellularity is typically moderate to high.…”

CD10 is useful to identify gastrointestinal contamination in endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) cytology from pancreatic ductal adenocarcinoma

“…Endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) is a minimally invasive procedure, widely used to diagnose both cystic and solid pancreatic lesions . In particular, EUS‐FNA cytology reliably identifies pancreatic ductal adenocarcinoma (PDA), the most common pancreatic malignancy .…”

“…Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive procedure, widely used to diagnose both cystic and solid pancreatic lesions. [1][2][3][4][5] In particular, EUS-FNA cytology reliably identifies pancreatic ductal adenocarcinoma (PDA), the most common pancreatic malignancy. 1,3 PDA has distinctive cytological features, displaying groups of atypical cells with irregular nuclear size, shape and contours, losing the benign-associated honeycomb pattern.…”