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Mesenchymal neoplasms of the tubular gut and adjacent structures: experience with EUS-guided fine-needle aspiration cytopathology.
J Am Soc Cytopathol. 2020 Jun 10 [Online ahead of print]JA

Abstract

INTRODUCTION

Unlike epithelial malignancies, mesenchymal neoplasms arising within the tubular gut are less often encountered in endoscopic ultrasound-guided (EUS) fine-needle aspiration biopsies (FNABs). Nonetheless, preoperative diagnosis of such neoplasms has important therapeutic and prognostic value. We report our experience with this category of neoplasms from the past decade.

MATERIALS AND METHODS

We performed a 10-year retrospective search at our respective institutions to identify EUS-guided FNAB cases of mesenchymal neoplasms arising from the tubular gut wall and closely adjacent structures. Cytopathologic diagnoses were compared to corresponding surgical pathology (SP) when available. Cases with either no confirmatory cell block (CB) immunohistochemical (IHC) staining, or no SP were excluded.

RESULTS

Two-hundred eighty-two cases (M:F = 1:1; age range: 25-94 years, mean age = 60 years) of EUS-guided FNAB from the tubular gut met our criteria. Onsite adequacy was performed on nearly all cases. Case numbers: 209 gastrointestinal stromal tumors (GIST), 58 smooth muscle neoplasms, and 15 miscellaneous neoplasms. Of these, 188 (67%) had SP follow-up. We found that 258 (91%) aspirates had a correct specific diagnosis, 3 (1%) were nondiagnostic, 18 (6%) had indeterminate diagnoses, and 3 (1%) had incorrect diagnoses (2 leiomyosarcomas mistaken as leiomyoma, and 1 fibrosclerotic lesion mistaken as inflammatory pseudotumor). Of 94 cases with no SP, all had a specific cytologic diagnosis based on confirmatory IHC staining from the CB including 61 GISTs, 29 smooth muscle neoplasms, and 4 miscellaneous tumors.

CONCLUSION

This study endorses the clinical utility of EUS-guided FNAB in the diagnosis of tubular gut mesenchymal neoplasms. A definitive and accurate diagnosis is possible in over 90% of cases, chiefly when cytomorphology is coupled with optimal cellularity and IHC from a concurrent CB. EUS-guided FNAB diagnosis of mesenchymal tubular gut neoplasms may play an important role in determining neoadjuvant therapy as targeted therapy evolves.

Authors+Show Affiliations

Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: paul.wakely@osumc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32622859

Citation

Jin, Ming, et al. "Mesenchymal Neoplasms of the Tubular Gut and Adjacent Structures: Experience With EUS-guided Fine-needle Aspiration Cytopathology." Journal of the American Society of Cytopathology, 2020.
Jin M, Chowsilpa S, Ali SZ, et al. Mesenchymal neoplasms of the tubular gut and adjacent structures: experience with EUS-guided fine-needle aspiration cytopathology. J Am Soc Cytopathol. 2020.
Jin, M., Chowsilpa, S., Ali, S. Z., & Wakely, P. E. (2020). Mesenchymal neoplasms of the tubular gut and adjacent structures: experience with EUS-guided fine-needle aspiration cytopathology. Journal of the American Society of Cytopathology. https://doi.org/10.1016/j.jasc.2020.05.009
Jin M, et al. Mesenchymal Neoplasms of the Tubular Gut and Adjacent Structures: Experience With EUS-guided Fine-needle Aspiration Cytopathology. J Am Soc Cytopathol. 2020 Jun 10; PubMed PMID: 32622859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mesenchymal neoplasms of the tubular gut and adjacent structures: experience with EUS-guided fine-needle aspiration cytopathology. AU - Jin,Ming, AU - Chowsilpa,Sayanan, AU - Ali,Syed Z, AU - Wakely,Paul E,Jr Y1 - 2020/06/10/ PY - 2020/05/16/received PY - 2020/05/23/revised PY - 2020/05/26/accepted PY - 2020/7/6/entrez PY - 2020/7/6/pubmed PY - 2020/7/6/medline KW - EUS-guided fine-needle aspiration biopsy KW - Gastrointestinal stromal tumor KW - Immunohistochemistry KW - Leiomyoma KW - Schwannoma KW - Tubular gut JF - Journal of the American Society of Cytopathology JO - J Am Soc Cytopathol N2 - INTRODUCTION: Unlike epithelial malignancies, mesenchymal neoplasms arising within the tubular gut are less often encountered in endoscopic ultrasound-guided (EUS) fine-needle aspiration biopsies (FNABs). Nonetheless, preoperative diagnosis of such neoplasms has important therapeutic and prognostic value. We report our experience with this category of neoplasms from the past decade. MATERIALS AND METHODS: We performed a 10-year retrospective search at our respective institutions to identify EUS-guided FNAB cases of mesenchymal neoplasms arising from the tubular gut wall and closely adjacent structures. Cytopathologic diagnoses were compared to corresponding surgical pathology (SP) when available. Cases with either no confirmatory cell block (CB) immunohistochemical (IHC) staining, or no SP were excluded. RESULTS: Two-hundred eighty-two cases (M:F = 1:1; age range: 25-94 years, mean age = 60 years) of EUS-guided FNAB from the tubular gut met our criteria. Onsite adequacy was performed on nearly all cases. Case numbers: 209 gastrointestinal stromal tumors (GIST), 58 smooth muscle neoplasms, and 15 miscellaneous neoplasms. Of these, 188 (67%) had SP follow-up. We found that 258 (91%) aspirates had a correct specific diagnosis, 3 (1%) were nondiagnostic, 18 (6%) had indeterminate diagnoses, and 3 (1%) had incorrect diagnoses (2 leiomyosarcomas mistaken as leiomyoma, and 1 fibrosclerotic lesion mistaken as inflammatory pseudotumor). Of 94 cases with no SP, all had a specific cytologic diagnosis based on confirmatory IHC staining from the CB including 61 GISTs, 29 smooth muscle neoplasms, and 4 miscellaneous tumors. CONCLUSION: This study endorses the clinical utility of EUS-guided FNAB in the diagnosis of tubular gut mesenchymal neoplasms. A definitive and accurate diagnosis is possible in over 90% of cases, chiefly when cytomorphology is coupled with optimal cellularity and IHC from a concurrent CB. EUS-guided FNAB diagnosis of mesenchymal tubular gut neoplasms may play an important role in determining neoadjuvant therapy as targeted therapy evolves. SN - 2213-2945 UR - https://www.unboundmedicine.com/medline/citation/32622859/Mesenchymal_neoplasms_of_the_tubular_gut_and_adjacent_structures:_experience_with_EUS-guided_fine-needle_aspiration_cytopathology L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2945(20)30090-9 DB - PRIME DP - Unbound Medicine ER -
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