This document provides information on gastrointestinal stromal tumors (GISTs), including:
- GISTs arise from interstitial cells of Cajal in the gastrointestinal tract and are defined by activating mutations in KIT or PDGFRA.
- Common symptoms are nonspecific but most GISTs are found in the stomach.
- Immunohistochemistry shows positivity for CD117 in 95% of cases, as well as DOG1, CD34, and protein kinase C theta.
- Risk stratification systems exist to determine malignant potential and guide treatment, which frequently involves tyrosine kinase inhibitors.
This presentation summarizes the state of the art with respect to the management of GIST. It covers the basics of surgical and medical management including the role of neoadjuvant and adjuvant targeted therapy. www.ellenhornmd.com
Gastric GIST by Dr Harsh Shah(www.gastroclinix.com)Dr Harsh Shah
GISTs are the commonest tumours of stomach. Their treatment is different from the traditional adenocarcinomas. Imatinib has an important role as neoadjuvant & adjuvant agent.
This presentation summarizes the state of the art with respect to the management of GIST. It covers the basics of surgical and medical management including the role of neoadjuvant and adjuvant targeted therapy. www.ellenhornmd.com
Gastric GIST by Dr Harsh Shah(www.gastroclinix.com)Dr Harsh Shah
GISTs are the commonest tumours of stomach. Their treatment is different from the traditional adenocarcinomas. Imatinib has an important role as neoadjuvant & adjuvant agent.
New Treatments for GERD and Barrett's EsophagusSummit Health
Learn the symptoms of Gastroesophageal Reflux Disease (GERD) and Barrett’s esophagus, and when they may warrant further medical attention. Hear the latest in treatment methods, including radio frequency ablation and endoscopic ultrasound.
Servikal İntraepitelyal Neoplazilerde (CIN) Yönetim nasıl olmalıdır?
HPV virüsü tipi takipte önemli midir? CIN1, CIN2 ve CIN3 te tedavi yöntemi ne olmalıdır?
Precision Medicine and its potential in Cancer management & treatment.pptxGunjitSetia1
Precision medicine is a revolutionary approach in healthcare that harnesses cutting-edge technologies and genetic insights to transform cancer management and treatment. By tailoring medical interventions to the unique genetic and molecular characteristics of each patient's cancer, precision medicine holds the potential to significantly improve outcomes and reduce side effects. In this era of personalized oncology, we explore the promising role of precision medicine in the battle against cancer, offering new avenues for early detection, targeted therapies, and more effective treatment strategies.
This slide explains about Germ cell tumor ovary (GCT Ovary). It explains how a various stages developmental anomaly could give rise to various types of GCT.
Upper GI bleed is a common, scary and life threatening medical condition usually caused by peptic ulcer disease or oesophageal varices. Uncommon causes include neoplasms, aortoenteric fistulas, vascular lesions, Dieulafoy's lesion etc. Patients usually present with hematemesis or melena. GIST is the third most common tumor of stomach and also the most common mesenchymal tumor. GIST may be asymptomatic and discovered incidentally or they may cause nonspecific symptoms like early satiety and fullness. Although major presentation of GIST is upper GI bleed, GIST as a cause of upper GI bleed is very rare. We here present a patient admitted to us with massive upper GI bleed due to gastrointestinal stromal tumor.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Gastrointerstinal stromal tumor (GIST) recent advances and differential diagnosis
1. GIST recent advances and
Differential diagnosis
Dr. Indira Shastry.K
Kasturba medical college
Manipal university, Manipal.
2. History
• Golden and Stout in 1941: described the mesenchymal tumors
arising in bowel as tumors arising from smooth muscle cells;
leiomyoblastoma, leiomyoma and leiomyosarcoma.
• Term GIST was 1st used by Mazur and Clark in 1983.
• In 1998 Japanese research workers (Hirota et al) discovered KIT
mutations in GIST that possibly distinguish GIST from other
tumors.
3. Definition & Terminology
• GI tract associated stromal (mesenchymal) neoplasm with
activating mutations in c-KIT (CD117) or PDGFR A, whose line of
differentiation recapitulates the interstitial cells of cajal and has
broad spectrum of biological behaviour.
• Stromal / mesenchymal tumors of GIT can be divided in to :
• Those identical to tumors arising from soft tissue in rest of the body :
Leiomyoma, Leiomyosarcoma, Neural tumors, hemangiomas, fibromas,
myofibroblastic tumors.
• Stromal tumors : GIST
MalignantBenign
4. Epidemiology &Incidence
• Age : 60-80 yrs / familial
(<30yrs)
• Gender: M=F.
• Most common benign non-
epithelial tumor of the GI
tract.
• 1% of primary GI cancers. 2.2%
primary gastric cancers (SEER
data).
• Oesophagus: 5%
• Stomach: 50-70%
• SI: 25-40%
• Duodenum – 10-20 %
• Jejunum – 27-37%
• Ileum : 27-53%
• Colorectal : 10%
• Extra - gastrointestinal GIST :
6.7% (AFIP)
5. Cell of origin c Cell of origin
• GIST, the specific KIT- or platelet-derived growth factor receptor-alpha
(PDGFRA)-signal driven mesenchymal tumor, arises from interstitial
cells of cajal (ICC).
• ICC are KIT + fibroblast like cells located around the myenteric plexus
and in the muscularis propria throughout the GI tract.
• ICC arise from precursor mesenchymal cells that ultra-structural and
immunophenotypic features of both neuronal and smooth muscle
differentiation (just like GIST) .
Kit positivity
7. Molecular biology
• C-KIT: (85-95%)
• Exon 11 (mutations / In-frame deletions): most
common type 70%. GIST with missense point
mutation at Exon 11 have better prognosis in Gastric
but not in other sites.
• Exon 9 : 2nd most common , commonly associated
with small bowel with known aggressive clinical
behaviour.
• Exon 13: involve missense mutations and associated
with more malignant potential.
8. Molecular biology
• PDGFR A:
• close homologues to KIT. PDGFRA mutations seen in 5-7% cases.
• Most PDGFRA mutant GIST are located in stomach with aggressive behaviour.
• Epithelioid morphology with weak / negative staining for CD117.
• These tumors are usually resistant to imatinib treatment.
• Wild type: (IGFR 1 mutation)
• 5-15 % of GIST do not harbour KIT / PDGFRA mutations
• Can be positive for CD117, less responsive to imatinib.
9. Sites Oesophagus Stomach Duodenum Jejunum and ileum
Incidence 5% 50-70% 10-20% 27-37% and 27-53%
respectively
Gender predilection Males Males, in young
females
M=F M=F
Site Lower 1/3rd or GE
junction
Antrum followed by
pylorus
2nd part of
duodenum
-
Gross (size of tumor) Usually >5cm in size
(Miettinen et al)
Variable Usually >4.5 cm Variable
Morphology Spindled or
epithelioid
MC-spindle (70%) Cellular, usually
>2mitosis/50 hpf
Variable
Behaviour and
prognosis
Aggressive •Good survival with
complete resection.
•73-81% behave in
benign fashion.
•30-50% are
malignant.
•Presence of
necrosis /
epithelioid change
lower the mitotic
threshold for
malignancy.
Worse outcome than
gastric GIST
GIST in various sites Recent advances -21
10. Colon Appendix Ano-rectum Extragastrointerstina
l GIST
Incidence 5% Very rare
(only 4 cases
reported till now )
5% 6.7%
Gender predilection M=F - - -
Site Ascending and
descending colon
- - Omentum, mesentry
and retroperitonium
Gross (size of tumor) Variable Variable Usually >5cm Omental GIST can be
large with low mitosis
Morphology Heterogeneous but
MC is spindle with
fascicles, pallisiding
or storiform pattern
•All 4 showed spindle
morphology, 3
contained skeinoid
fibers
•Low mitosis
(<1/50hpf)
Variable
>5mitosis /50hpf
Variable
Behaviour and
prognosis
Variable •Good prognosis.
•Mets to liver and
lung observed after
10-15 yrs
32-54% malignant Omental GIST
resemble stomach
GIST.
Mesentric GIST
resemble SI GIST
20. Heredity Mean Age M/F
Associated
Lesions
Mutations GIST Location Behaviour
Familial AD 45 M&F
Mast cell
lesions,
achalasia
GL KIT
/PDGFRA
Small intestine
Frequently
aggressive
Carney –
stratakis
AD 23 M&F Paraganglioma
GL SDH, No KIT
/ PDGFRA
Stomach
epithelioid
GIST mets but
protracted,
Paragang.
aggressive
Carney triad None <30 >95%F
Lung
chondroma,
paraganglioma
No KIT /
PDGFRA or SDH
Stomach
epithelioid
Mets (LN)but
protracted
course
NF 1 AD 40-50 M&F
Neurofibromato
sis
GL SDH, No KIT
/ PDGFRA
Small intestine
spindled
As for usual
Sporadic SDHB
deficient
(pediatric
type)
None
<16, rarely also
adults
>90%F None
No KIT /
PDGFRA or SDH
Stomach
epithelioid
Mets but
protracted
course, may go
to nodes
Sporadic
multiple
None 60 M&F None As for usual
Usually
stomach
Most are benign
GIST syndromes
21. IHC
• DOG 1 (discovered on GIST 1): 87-97.8%
• CD117 up to 95%
• Protein kinase C theta – 96%
• Heavy caldesmon -80%
• CD 34 -70%
• Nestin – non specific (pos in schwannoma, leiomyosarcoma and melanoma)
• Smooth muscle actin 20-30%
• S100 – 5% ( 15-20% in SI GIST, more frequent in NF 1 associated GIST)
• Desmin & CK – 1-2%
• SDHB ( succinate dehydrogenase B) – loss of staining in syndromic or
paediatric GIST.
22. DOG1 (discovered on GIST1)
• Novel gene that encodes for protein called calcium regulated chloride
channel protein.
• In a study conducted by West et al immunoreactivity for DOG1 in GIST
samples was 97.8%. Espinosa et al showed 87% sensitivity and specificity.
• DOG1 is highly expressed not only in typical GISTs but also in kit mutation-
negative GISTs.
• 5% of GIST that do not react with CD117, DOG 1 would be essential tool for
more reliable diagnosis of GIST.
• DOG 1 +ty also identified in subset of mesenchymal tumors – leiomyomas
and synovial sarcomas.
26. CD 117
• CD117/KIT : +ve in >95% tumors but no longer considered absolute
requirement.
• Other tumors show consistent positivity include:
• Mastocytoma
• Seminoma (membranous)
• Lung small cell carcinoma
• Extramedullary myleoid tumors.
27. • Other metastatic abdominal tumors that test positive for CD117
include
• Metastatic melanoma
• Clear cell sarcoma (30-50%)
• Ewings sarcoma (50%)
• Childhood neuroblastoma (30%)
• Angiosarcoma (50%)
• Poorly differentiated carcinomas
28. Protein Kinase C Theta (PKCT)
• Downstream effector in Kit signaling system involved in T cell activation,
signal transduction and neuronal differentiation.
• Strongly over expressed in GIST but not in sarcomas
• In study done by Kim et al 96% GIST was positive for PKCT were as 98%
cases were positive for CD117.
• Some investigators believe PKCT signaling in weaker than KIT hence it is
less useful.
31. TNM staging
• The 7th ed of the international union against cancer (UICC) in 2010
published for the first time, a classification and staging system for GIST
using the TNM system.
• AIM : uniform and standardized analysis of malignant tumors based on
their stage of development and degree of spread.
• Joensuu et al (2011) concluded large tumor size, high mitotic count, non-
gastric location, presence of rupture, and male sex were the independent
prognostic factors for recurrent free survival.
37. Palisading is more accentuated in GIST; CD34 stains 0-33% of GI
schwannomas
GI schwannoma GIST (spindled, bland)
Peripheral lymphoid cuff common Lacks lymphoid cuff
Frequent cell size variation Generally uniform cell size
No skeinoid fibers May have skeinoid fibers
S100 -100% S100 -5% (20% in small intestine)
GFAP - 65-100% GFAP - negative
CD117 -negative CD117 -74-95%
38. Fibromatosis
(mesentric or retroperitonial and
pelvic)
GIST
CD34 - negative CD34- 60-70% positive
CD117 -frequently negative, variable reports of
focal/weak staining
CD117- 74-95% positive
DOG1 -negative DOG1- 87-94%
Beta-catenin positive -90% (nuclear) Beta-catenin- negative
Low to moderate cellularity Moderate to high cellularity
Cytologically bland May be cytologically atypical
Prominent thin walled dilated veins Lacks prominent veins
Infiltrative margin Usually circumscribed, pushing margin
No cystic degeneration or necrosis May have cystic degeneration or necrosis
39. Sclerosing Mesenteritis GIST (spindled, bland)
Lobulated paucicellular fibrosis
Not typically lobulated, usually
cellular rather than fibrotic
Prominent chronic inflammatory infiltrate Inflammation not typical
Entrapped fat and fat necrosis
Lobules of entrapped fat and fat
necrosis unusual
40. GIST Solitary fibrous tumor
Spindled or epithelioid cytoplasm Scant cytoplasm
Skeinoid fibers: are irregular, globular and
have prominent retraction
Ropy collagen
Hemangiopericytoma-like vessels uncommon HPC-like vessels common
CD117 (KIT) 74-95%, DOG1 87-95% positive CD117, DOG1 negative
Actin 30-50% positive Actin rare and focal
CD34 is usually positive in both
41.
42. Inflammatory myofibroblastic
tumor
GIST
Usually in children Rare in children
Frequently associated with systemic signs and
symptoms
Not associated with systemic signs and
symptoms
Prominent inflammatory cells Usually only scattered inflammatory cells
Positive - desmin, keratin and ALK Desmin (1-2%), keratin and ALK – negative
CD117, DOG1, CD34 - negative CD117, DOG1, CD34- positive
43. Endometrial Stromal
Sarcoma (Metastatic)
GIST (spindled, bland)
History of prior hysterectomy No such history
May arise in endometriosis Not associated with endometriosis
Prominent spiral arterioles Hyalinized larger vessels
CD10, ER and PR - positive ER and PR negative
DOG1 - negative DOG1 87-94%
44. Calcifying fibrous pseudo
tumor
GIST (spindled, bland)
Calcification frequently psammomatous
Calcification dystrophic, not
psammomatous
Patchy chronic inflammation Inflammation not typical
May form multinodular mass Not typically multinodular
Prominent hyalinized stroma
Stroma occasionally sclerotic but not
usually hyalinized
46. Epithelioid GIST
Poorly Differentiated
Carcinoma
GIST
May have a mucosal component or form
glands
No mucosal component or true glands
Frequently markedly pleomorphic
Pleomorphism infrequent, even in
malignant lesions
Mucin stain may be positive No mucin
Keratin positive Keratin 1-2%
CD34 negative CD34 70%
DOG1 negative DOG1 87-94%%
48. GI mucosal
benign epithelial
nerve sheeth
tumor
Extramedullary
Myeloid Tumor
GI Endocrine
Carcinoma
Gangliocytic
Paraganglioma
Glomus Tumor GIST(epithelioid)
Centered in
lamina propria or
submucosa
Frequent history
of leukemia
Nuclei round and
regular
Three cell types:
epithelioid,
ganglion, spindled
Nuclei round and
regular
Nuclei usually
oval or spindled
S100 positive
Eosinophilic
myelocytes
frequently
present
Stippled (salt and
pepper)
chromatin
Synaptophysin
and chromogranin
positive
Distinct cell
borders
Cell borders may
be indistinct
CD117 negative
Infiltration along
collagen fibers
Keratin positive
cells
Keratin positive
epithelioid cells
Mitotic rate
usually <1/50 HPF
Mitotic rate can
be higher
CD34 negative
CD45, CD43,
myeloperoxidase
positive
Synaptophysin
and chromogranin
positive
CD117 negative CD117 negative CD117 74-95%
Restricted to
colon
Extramedullary
Myeloid Tumor
CD117 negative
Gangliocytic
Paraganglioma
Smooth muscle
actin positive
Smooth muscle
actin frequently
negative
49. References
• Morson and Dawson’s GI pathology ; 5th ed.
• Recent advances in histopathology ; 21 vol
• Rosai and Akerman surgical pathology 10th ed
• WHO pathology and genetics of tumors of digestive system. 2003.
• Christopher B Tan et al ; Gastrointestinal Stromal Tumors: A Review of Case Reports, Diagnosis,
Treatment, and Future Directions. International Scholarly Research Network gastroenterology.
2012.
• Novelli M et al. DOG1 and CD117 are the antibodies of choice in the diagnosis of
gastrointestinal stromal tumours. Histopathology 2010, 57.
• Hadi MA et al. Evaluation of the Novel Monoclonal Antibody Against DOG1 as a Diagnostic
Marker for Gastrointestinal Stromal Tumors. Journal of the Egyptian Nat. Cancer Inst. 2009,
Vol. 21.
• Stanford university website.
CD117 is NOT expressed by: smooth muscle tumours, neural tumours, yolk sac tumours
Joensuu et al compared the NIH criteria, the modified NIH criteria and the AFIP system for risk stratification for recurrence-free survival (RFS) in imatinib naive operable GISTs.