40 yr male,exophytic growth of 12*15 cms over ascending colon involving mesocolon..smear for interpretation..

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Respected mam, thank you for sharing this case. Section shows a neoplasm composed of spindle cells arranged in interlacing fascicles and herring bone pattern. The neoplastic spindle cells have oval to elongated nuclei (at places appear cigar shaped ) exhibiting moderate pleomorphism and moderate cytoplasm with indistinct cell borders. A few mitotic fig are noted. No necrosis is seen. A few dilated blood vessels are seen. Focal myxoid change is seen. No lipoblasts seen. Impression : SPINDLE CELL NEOPLASM, biopsy mesocolon growth. Advised IHC for further Subtyping. Panel : VIMENTIN, CD117, DOG1, SMA, CD 34, S100, beta CATENIN and ki67 D/D: 1. GIST 2. LEIOMYOMA / sarcoma 3. SCHWANNOMA/Neurofibroma 4. Fibromatosis 5. Fibrosarcoma 6. Vascular tumour Note : Mam, the diagnosis was given as neoplasm instead of sarcoma as cellular atypia is known to occur in benign tumour. Also occasional mitotic fig are seen. To grade as sarcoma, FNCLCC grading is used ( differentition, mitotic fig, necrosis) with exceptions like GIST etc. Here proliferative index can be used. Although herring bone pattern is classically described in fibrosarcoma, it can occur in other neoplasms too. And moreover fibrosarcoma is a diagnosis of exclusion. Thank you mam. Keep us updated. Regards...

Respected sir.. This case was being reported as GIST on microscopy n on ihc it was proven to be MPNST.. Thank you sir for valuable discussion..
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Section shows.... Tumour cells arranged in small fasicles..... Individual cells are predominantly spindled in shape.... Some of them are epitheloid also.... With hyper chromatism.... it's a spindle cell neoplasm....Most probably... Gist.... Do Ihc to rule out....

Spindle cell neoplasm possibly GIST or schwannomma

Over all finding suggestive of: spindle cell tumour ?Gist with malignant potential ? Leiomyosarcoma ? Schwannoma ? Fibromatosis ?fibrosarcoma Adv: IHC markers

looking at the morphology the first thing that comes to mind is a malignant GIST. However, few hyalinized vessels and presence of RBCs in the last 2 photographs pops up a consideration of Angiosarcoma as well. CD117 and CD 31 atleast needs evaluation as a primary step.

the sections show a cellular spindle cell tumour with predominantly fascicular pattern of grown exhibiting herring pattern and cells arranged in short fascicles. Individual

the sections show a cellular spindle cell tumour with predominently fascicular pattern or growth with cells arranged in short fascicles and exhibiting herring bone pattern of growth. Individual cells have pleomorphic nucleii with moderate anisokaryosis. Nucleii are oval elongated and spindle shaped with blunted or pointed ends. Chromation appears mildly hyperchromatic. Few nucleii have indentations and prominant nucleoli. Cytoplasm is scanty with indistinct cell borders. Epitheloid like cells are seen. Few mitotic figures are noted. Vascularity is prominant with prominant mildly thickened walls, dilatiation and gaping with congestion or hyperemia. There seems to be a mild diffuse mononuclear cell infiltrate with extravasation of rbc's. Secondary degeneration myxohyaline changes is noted. Necrosis is absent. IMPRESSION..The overall picture is suggestive of a spindle cell tumour, most likely to be malignant..(lookd deceptively benign).. D/D 1. GIST 2. Leiomyosarcoma. 3. Fibrosarcoma 4. MPNST ADVISE..1. Clinicopathological n radiological correlation 2. IHC for final diagnosis.
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cellular schwannoma or epithelium gist

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