Qap (Anatomical Pathology) 

QAP Peer Review

AP182
Case History: F/56 Upper gastrointestinal bleeding. Polypoid mass found in gastric wall
Intended diagnosis: Schwannoma. Contributed by:JKCC
Code Diagnosis Comment Score
anonymous Schwannoma (70%). Differential diagnosis: Gastrointestinal stromal tumour, GIST (30%) To perform immunostains for S100, c-kit and CD34. Schwannoma will be positive for S100 while gastrointestinal stromal tumour (GIST) will be positive for c-kit and CD34.  100
anonymous Gastrointestinal stromal tumor Combined with tumor size and mitotic figure for malignant behavior  40
anonymous Spindle cell tumor consistent with Schwannoma. DDx GIST and leiomyoma. Immunos to confirm schwannoma (S-100 protein +ve) GIST (+ve C-kit +/- CD34) Leiomyoma (Smooth muscle actin +ve)  100
anonymous Schwannoma Confirm by immunostaining for S100. Differential diagnosis: Gastrointestinal stromal tumor (C-kit positive).  100
anonymous Neurilemoma 70% Gastrointestinal stromal tumor 30%. Immunostains can help arrive at a definitive diagnosis. S100 +ve in schwannoma. C-kit +ve in GIST.  100
anonymous Spindle cell tumor. Schwannoma needs to be considered. DDx includes GIST, smooth muscle tumor, etc. (100%) Do S100 protein to support schwannoma. c-kit and CD34 for GIST; desmin and actin for smooth muscle tumor.  100
anonymous Stomach - Schwannoma 99% GIST 1% To correlate with immunostains results of S-100 protein and c-kit  100
anonymous Gastrointestinal stromal tumour (GIST)(70%), Schwannoma (30%) Areas of ? infarct/? hyaline change, low mitotic count in this block. Examine more blocks and correlate with the size of the tumour to determine the malignant potential. Immunohistochemistry panel : Most GIST are c-kit positive. Need to exclude other stromal tumours: S100 (positive for schwannoma), smooth muscle neoplasms are SMA and desmin positive. Cytokeratin to rule out the remote possibility of spindle cell carcinoma.  60
anonymous Spindle cell tumor: 1) Follicular dentritic cell tumor? 2) Peripheral nerve sheath tumor? 3) Gastrointestinal stromal tumor? nil  50
anonymous SPINDLE CELL TUMOUR of gastric wall, morphologically suggestive of Schwannoma, differential diagnosis include Gastrointestinal stromal tumour. Require immunohistochemical staining for differential diagnosis. (100%) nil  100
anonymous Schwannoma 75% GIST 25% S100 to confirm nerve sheath origin c-kit, CD34 to exclude GIST desmin to exclude leiomyoma  100
anonymous Gastric spindled cell tumor Differential diagnoses are schwannoma and gastrointestinal stromal tumor. To be differentiated by immunohistochemical staining: S100, CD117  80
anonymous Gastrointestinal stroma tumor/Gastrointestinal autonomic nerve tumor (GIST/GANT) nil  40
anonymous Neurilemmoma. Do S100 to confirm, also do CD117, CD34 to exclude GIST and desmin and SMA for smooth muscle tumour. Probability: 100% nil  100
anonymous Gastrointestinal mesenchymal tumour (100%), favour Schwannoma (80%). Gastrointestinal stromal tumour (GIST) (20%) Perform S100 protein immunostain to confirm schwannoma, CD117 to rule out GIST and actin to rule out smooth muscle tumour.  100
anonymous Neurilemmoma (50%) Gastrointestinal stromal tumour (50%) Immunohistochemical staining for S-100 protein, CD34, c-kit, SMA and desmin for definitive diagnosis.  80