Smooth muscle tumors of the gastrointestinal tract: an analysis of prognostic features in 407 cases

被引：18

作者：

Alpert, Lindsay ^{[1
]}

Al-Sabti, Ram ^{[1
]}

Graham, Rondell P. ^{[2
]}

Pai, Rish K. ^{[3
]}

Gonzalez, Raul S. ^{[4
]}

Zhang, Xuefeng ^{[5
]}

Smith, Vanessa ^{[5
]}

Wang, Hanlin L. ^{[6
]}

Westbrook, Lindsey ^{[6
]}

Goldblum, John R. ^{[7
]}

Bakhshwin, Ahmed ^{[7
]}

Shetty, Sindhu ^{[7
]}

Klimstra, David S. ^{[8
]}

Shia, Jinru ^{[8
]}

Askan, Gokce ^{[8
]}

Robert, Marie E. ^{[9
]}

Thomas, Courtney ^{[9
]}

Frankel, Wendy L. ^{[10
]}

Alsomali, Mohammed ^{[10
]}

Hagen, Catherine ^{[11
]}

Mostafa, Mohamed E. ^{[11
]}

Feely, Michael M. ^{[12
]}

Assarzadegan, Naziheh ^{[12
]}

Misdraji, Joseph ^{[13
]}

Shih, Angela R. ^{[13
]}

Agostini-Vulaj, Diana ^{[14
]}

Meis, Jeanne M. ^{[15
]}

Tang, Sherry ^{[15
]}

Chatterjee, Deyali ^{[16
]}

Kang, Liang-, I ^{[16
]}

Hart, John ^{[1
]}

Lee, Sang Mee ^{[1
]}

Smith, Theresa ^{[17
]}

Yantiss, Rhonda K. ^{[18
]}

Hissong, Erika M. ^{[18
]}

Gao, Zu-hua ^{[19
]}

Wu, JingBo ^{[19
]}

Resnick, Murray B. ^{[20
]}

Wu, Elizabeth Yiru ^{[20
]}

Pai, Reet K. ^{[21
]}

Zhao, Lei ^{[22
]}

Doyle, Leona A. ^{[22
]}

Chopra, Shefali ^{[23
]}

Panarelli, Nicole C. ^{[24
]}

Hu, Shaomin ^{[24
]}

Longacre, Teri A. ^{[25
]}

Raghavan, Shyam Sampath ^{[25
]}

Lauwers, Gregory Y. ^{[26
]}

Ghayouri, Masoumeh ^{[26
]}

Cooper, Harry S. ^{[27
]}

机构：

[1] Univ Chicago, Chicago, IL 60637 USA

[2] Mayo Clin, Rochester, MN USA

[3] Mayo Clin, Scottsdale, AZ USA

[4] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[5] Duke Univ, Med Ctr, Durham, NC USA

[6] UCLA, David Geffen Sch Med, Los Angeles, CA 90095 USA

[7] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA

[8] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA

[9] Yale Univ, Sch Med, New Haven, CT USA

[10] Ohio State Univ, Wexner Med Ctr, Columbus, OH 43210 USA

[11] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[12] Univ Florida, Gainesville, FL USA

[13] Massachusetts Gen Hosp, Boston, MA 02114 USA

[14] Univ Rochester, Med Ctr, Rochester, NY 14642 USA

[15] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[16] Washington Univ, Sch Med, St Louis, MO USA

[17] Roswell Park Comprehens Canc Ctr, Buffalo, NY USA

[18] Weill Cornell Med, New York, NY USA

[19] McGill Univ, Montreal, PQ, Canada

[20] Brown Univ, Lifespan Warren Alpert Med Sch, Providence, RI 02912 USA

[21] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA

[22] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[23] Univ Southern Calif, Keck Med Ctr, Los Angeles, CA 90007 USA

[24] Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA

[25] Stanford Univ, Stanford, CA 94305 USA

[26] H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA

[27] Fox Chase Canc Ctr, 7701 Burholme Ave, Philadelphia, PA 19111 USA

[28] Univ Iowa Hlth Care, Iowa City, IA USA

[29] Univ Calif San Francisco, San Francisco, CA 94143 USA

[30] Univ Calif San Diego, La Jolla, CA 92093 USA

[31] Univ Michigan, Ann Arbor, MI 48109 USA

[32] Univ Utah, Salt Lake City, UT USA

来源：

MODERN PATHOLOGY | 2020年 / 33卷 / 07期

关键词：

STROMAL TUMORS; SOFT-TISSUE; LEIOMYOMAS; LEIOMYOSARCOMAS; CLASSIFICATION;

D O I：

10.1038/s41379-020-0492-5

中图分类号：

R36 [病理学];

学科分类号：

100104 ;

摘要：

Smooth muscle tumors represent the second most common mural mesenchymal neoplasm in the gastrointestinal tract, but established criteria for prognostic assessment of these tumors are lacking. A large cohort of surgically resected intramural gastrointestinal smooth muscle tumors from 31 institutions was analyzed to identify potential prognostic features. Pathologic features were assessed by expert gastrointestinal and/or soft tissue pathologists at each center. Immunohistochemical confirmation was required. A total of 407 cases from the esophagus (n = 97, 24%), stomach (n = 180, 44%), small bowel (n = 74, 18%), and colorectum (n = 56, 14%) were identified. Patients ranged in age from 19 to 92 years (mean 55 years), with a slight female predominance (57%). Mean tumor size was 5.4 cm, with the largest tumor measuring 29 cm. Disease progression following surgery, defined as local recurrence, metastasis, or disease-related death, occurred in 56 patients (14%). Colorectal tumors were most likely to progress, followed by small bowel and gastric tumors. None of the esophageal tumors in this series progressed. Receiver operator characteristic analysis identified optimal cutoffs of 9.8 cm and 3 mitoses/5 mm(2) for discriminating between progressive and non-progressive tumors. Histologic features strongly associated with progression by univariate analysis included moderate-to-severe atypia, high cellularity, abnormal differentiation (defined as differentiation not closely resembling that of normal smooth muscle), tumor necrosis, mucosal ulceration, lamina propria involvement, and serosal involvement (P < 0.0001 for all features). Age, sex, and margin status were not significantly associated with progression (P = 0.23, 0.82, and 0.07, respectively). A risk assessment table was created based on tumor site, size, and mitotic count, and Kaplan-Meier plots of progression-free survival for each subgroup revealed progression-based tiers. Based on our findings, it appears that nonesophageal gastrointestinal smooth muscle tumors measuring >10 cm and/or showing >= 3 mitoses/5 mm(2) may behave aggressively, and therefore close clinical follow-up is recommended in these cases.

引用

页码：1410 / 1419

页数：10