—  SHORT COURSE #22  —

Tumors In The Liver - Diagnostic Problems

Case 9 - Metastatic Gastrointestinal Stromal Sarcoma

Linda D. Ferrell, M.D.
Wendy L. Frankel, M.D.


Clinical findings:
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.


Case 9 - Figure 1 - Spindled cell tumor in the liver, low power
Case 9 - Figure 2 - Cellular, spindle cell proliferation of atypical cells, high power

Case 9 - Figure 3 -
Case 9 - Figure 4 - Positive CKit immunostain, high power


Pathologic findings:
Cellular epithelioid and spindled cell tumor in the liver. There are occasional mitotic figures and cytologic atypia.

Diagnosis - Metastatic Gastrointestinal Stromal Sarcoma

Comments


Metastatic 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 liver.

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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