Intraparietal esophageal leiomyomas diagnosed by endoscopic ultrasound-guided fine-needle aspiration cytology: Cytological and immunocytochemical features in two cases

Abstract

Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) has proven to be of significant value as a diagnostic method for the evaluation of esophageal mesenchymal tumors, such as true leiomyomas. Utilizing the cell block procedure, the present study reports the diagnostic approach of EUS-FNAC in two patients affected by this lesion, describing the cytological and immunocytochemical findings. Spindle-shaped elements with elongated nuclei were appreciable; moreover, the cytoplasmatic immunohistochemical positivity for smooth muscle actin and desmin strongly supported the diagnosis of leiomyoma when also taking into account the constant negativity for CD34, CD117 and S100. The differential diagnosis between spindle cell mesenchymal tumors and leiomyomas, and the clinico-therapeutic management of the latter are also discussed in the study.

Cytopathology of rare gastric mesenchymal neoplasms: A series of 25 cases and review of literature

“…Follow‐up with EUS has been considered preferable. The indications for surgical excision include unremitting symptoms, progressive increase in tumour size, mucosal ulceration, and the necessity to obtain a histological diagnosis due to inadequate/inconclusive EUS‐FNA 8 . A risk assessment tool for smooth muscle tumours of the GI tract was developed by Alpert et al to predict their behaviour.…”

“…7 Gastrointestinal leiomyomas are frequently asymptomatic and are most commonly detected incidentally during endoscopic workup for other diseases such as gastroesophageal reflux disease, gastritis, abdominal pain, and other diseases. 8 On imaging, leiomyomas appear as homogenous, low attenuated masses with an endoluminal growth pattern on CT scan. 1 Microscopically, leiomyomas are composed of fascicles of spindle-shaped smooth muscle cells with abundant eosinophilic cytoplasm and oval regular pale nuclei.…”

“…obtain a histological diagnosis due to inadequate/inconclusive EUS-FNA. 8 A risk assessment tool for smooth muscle tumours of the GI tract was developed by Alpert et al to predict their behaviour. They concluded that non-oesophageal tumours measuring >10 cm and/ or showing ≥3 mitoses/5 mm 2 can behave aggressively and thus require close follow-up.…”

Diagnostic relevance of cell block procedure in secondary tumors of the pancreas

“…[ 1 2 3 ] In fact, this technique allows better preservation of cell architecture with the achievement of routine hematoxylin-eosin staining and finally, the possibility to perform ancillary methods, such as immunohistochemistry or molecular analyses. [ 2 3 8 9 ] In particular, CBP allows the availability of an adequate number of serial sections, with the chance to perform a precise immunohistochemical algorithm for the differential diagnostic purposes; however, also Alomari et al .,[ 1 ] stressed the utilization of immunostained cell block sections in selective cases.…”