Onkologie. 2014:8(6):259-263

Gastrointestinal stromal tumors, morphological and immunohistochemical study. Forceps versus endoscopic

Dušan Žiak^1,2, Jana Dvořáčková^1,2,3, Pavel Hurník^1,2,3, Vladimír Židlík², Jarmila Šustíková², Jarmila Šimová², Magdalena Uvírová², Radoslava Tomanová¹, Martin Kliment⁵, Ondřej Urban5, Vincent Zoundjiekpon⁵, Oldřich Motyka⁴, Petr Dítě⁶

¹ Ústav patologie Fakultní nemocnice Ostrava

² CGB laboratoř a.s., Vzdělávací a výzkumný institut AGEL, o.p.s. – pobočka Ostrava-Vítkovice

³ Lékařská fakulta Ostravské univerzity, Ostrava

⁴ Oddělení anorganické analýzy, Centrum nanotechnologií, Vysoká škola báňská – Technická univerzita, Ostrava

Centrum péče o zažívací trakt Vítkovická nemocnice, Vzdělávací a výzkumný institut AGEL, o.p.s. –

⁵ pobočka Ostrava-Vítkovice

⁶ Interní klinika Fakultní nemocnice Ostrava

ultrasound-guided fine-needle aspiration biopsy

Gastrointestinal stromal tumors (GIST) belong to the most common mesenchymal tumors of digestive tract deriving from Cajal interstitial

cells. A panel of immunohistochemical antibodies CD117, desmin, S100 and DOG1 is used to confirm the morphological diagnosis. When

evaluating the biological characteristics we used a Miettinen classification for GIST which divides tumors into three groups according to

a risk of aggressive behaviour. This classification observes three parameters – tumor localisation, its size and mitotic index. Mitotic index is

defined as a number of mitoses in the tumor tissue on the overall area of 5 mm2. We performed a comparison of sampling methods – biopsy

forceps, resection versus endoscopic ultrasound-guided fine-needle aspiration cytology (EUS FNA) from the point of view of a pathologist,

focusing on the assessment of all necessary morphological and prognostic parameters of neoplasia. The study conclusions and experience

show that when diagnosing GISTs, results of cytological examination of a sample using EUS FNA are comparable to those using forceps endoscopic

biopsy. The main limitation of EUS FNA method is that in 75 % of cases it is impossible to state the mitotic index due to insufficient

amount of tumor tissue. This tissue deficit may be replaced with an examination of a nuclear protein associated with cell proliferation Ki 67

which appears to be an independent prognostic parameter of disease progression.

Keywords: gastrointestinal stromal tumor, fine needle aspiration cytology – EUS FNA, biopsy forceps, mitotic index, Ki-67, prognostic

Published: December 15, 2014  Show citation