Tumors In The Liver - Diagnostic Problems
Case 9 -
Metastatic Gastrointestinal Stromal Sarcoma
Linda D. Ferrell, M.D.
Wendy L. Frankel, M.D.
50 year old man presented with 2 week history of
hematemesis and epigastric pain, and EGD and CT demonstrated a large gastric mass. At surgery he was
found to also have a 5 cm liver mass.
Cellular epithelioid and spindled cell tumor in the
liver. There are occasional mitotic figures and cytologic atypia.
Diagnosis - Metastatic Gastrointestinal Stromal Sarcoma
Clinical features. History of sarcoma. Sarcomas that
metastasize to the liver include gastrointestinal stromal sarcomas and soft tissue sarcomas. Patients
generally present with mass effect or nonspecific symptoms and elevated liver function tests.
Gross features. May present with multiple lesions.
Microscopic features. Reflects the histology of the primary tumor.
Differential diagnosis. Sarcomatoid carcinomas including HCC can mimic a sarcoma.
Primary soft tissue sarcomas have been reported to occur in the liver. Liposarcoma, malignant fibrous
histiocytoma, dendritic reticulin sarcoma, fibrosarcoma, among others have all been reported in the
Special studies. Immunohistochemical studies are very useful the help identify the
tumor. Useful stains include cytokeratins, vimentin, CD117 (C-kit), CD34, S-100, and SMA.
Spindle cell tumors: Low molecular weight cytokeratins may help identify a carcinoma. Do not forget
about metastatic sarcomas most commonly gastrointestinal stromal tumor (CD34+, Ckit+, Bcl-2+, SMA-,
S-100-). Vascular tumors should be immunoreactive with CD31 and CD34.
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