Gastric Plexiform Fibromyxoma: A Great Mimic of Gastrointestinal Stromal Tumor (GIST) and Diagnostic Pitfalls

Jinping Lai, Jesse L. Kresak, Dengfeng Cao, Dongwei Zhang, Sharon Zhang, Marino E. Leon, Archana Shenoy, Weidong Liu, Jose Trevino, Petr Starostik, David Hernandez Gonzalo, Hanlin Wang, Xiuli Liu, Xuemo Fan

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Abstract

Through a multicenter study, we collected seven cases of gastric plexiform fibromyxoma including four females and three males, 21 to 79 y old (46.1 ± 10.1). All cases showed a unilocular lesion measuring 0.3 to 17 cm (5.3 ± 2.4), arising from antrum (5/7) or body (2/7). Six of the seven cases had intraoperative frozen sections and/or endoscopic ultrasound fine needle aspiration (EUS-FNA), and all of them were preoperatively or intraoperatively diagnosed as gastrointestinal stromal tumor (GIST). EUS-FNA material showed markedly elongated spindle cells with streaming oval to elongated nuclei with rounded ends. Histologically, the tumors exhibited a plexiform growth pattern and were composed of a rich myxoid stroma and cytologically bland uniform spindle cells without mitotic figures, with the exception of one case which displayed nuclear pleomorphism and increased mitosis. Immunostains showed the tumor cells to be focally positive for SMA (6/6), focally and weakly positive for desmin (3/6) and caldesmon (2/3), negative for CD117 (0/7), CD34 (0/7), DOG1 (0/4), and S100 (0/5). No mutations were identified on Next-Generation Sequencing test, and no loss of SDHB immunoreactivity was identified in the tumor with nuclear pleomorphism. One case was treated with Gleevec because of the initial diagnosis of GIST. All patients had a follow-up for up to 11 y, with no tumor recurrence or metastasis reported. Our results suggest that gastric plexiform fibromyxoma is rare and may be underrecognized and misinterpreted as GIST during intraoperative frozen section or preoperative EUS-FNA diagnosis without immunostains leading to inappropriate treatment.

Original languageEnglish
Pages (from-to)76-82
Number of pages7
JournalJournal of Surgical Research
Volume239
DOIs
StatePublished - Jul 2019

Keywords

  • Endoscopic ultrasound-guided fine needle aspiration
  • Gastric plexiform fibromyxoma
  • Gastrointestinal stromal tumor
  • Immunohistochemistry
  • Intraoperative frozen section
  • Next-Generation Sequencing

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    Lai, J., Kresak, J. L., Cao, D., Zhang, D., Zhang, S., Leon, M. E., Shenoy, A., Liu, W., Trevino, J., Starostik, P., Gonzalo, D. H., Wang, H., Liu, X., & Fan, X. (2019). Gastric Plexiform Fibromyxoma: A Great Mimic of Gastrointestinal Stromal Tumor (GIST) and Diagnostic Pitfalls. Journal of Surgical Research, 239, 76-82. https://doi.org/10.1016/j.jss.2019.01.062