TY - JOUR
T1 - Smooth muscle tumors of the gastrointestinal tract
T2 - an analysis of prognostic features in 407 cases
AU - Alpert, Lindsay
AU - Al-Sabti, Ram
AU - Graham, Rondell P.
AU - Pai, Rish K.
AU - Gonzalez, Raul S.
AU - Zhang, Xuefeng
AU - Smith, Vanessa
AU - Wang, Hanlin L.
AU - Westbrook, Lindsey
AU - Goldblum, John R.
AU - Bakhshwin, Ahmed
AU - Shetty, Sindhu
AU - Klimstra, David S.
AU - Shia, Jinru
AU - Askan, Gokce
AU - Robert, Marie E.
AU - Thomas, Courtney
AU - Frankel, Wendy L.
AU - Alsomali, Mohammed
AU - Hagen, Catherine
AU - Mostafa, Mohamed E.
AU - Feely, Michael M.
AU - Assarzadegan, Naziheh
AU - Misdraji, Joseph
AU - Shih, Angela R.
AU - Agostini-Vulaj, Diana
AU - Meis, Jeanne M.
AU - Tang, Sherry
AU - Chatterjee, Deyali
AU - Kang, Liang I.
AU - Hart, John
AU - Lee, Sang Mee
AU - Smith, Theresa
AU - Yantiss, Rhonda K.
AU - Hissong, Erika M.
AU - Gao, Zu hua
AU - Wu, Jing Bo
AU - Resnick, Murray B.
AU - Wu, Elizabeth Yiru
AU - Pai, Reet K.
AU - Zhao, Lei
AU - Doyle, Leona A.
AU - Chopra, Shefali
AU - Panarelli, Nicole C.
AU - Hu, Shaomin
AU - Longacre, Teri A.
AU - Raghavan, Shyam Sampath
AU - Lauwers, Gregory Y.
AU - Ghayouri, Masoumeh
AU - Cooper, Harry S.
AU - Nagarathinam, Rajeswari
AU - Bellizzi, Andrew M.
AU - Kakar, Sanjay
AU - Hosseini, Mojgan
AU - Rong, Juan
AU - Greenson, Joel K.
AU - Lamps, Laura W.
AU - Dong, Zachary
AU - Bronner, Mary P.
N1 - Publisher Copyright:
© 2020, The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - 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 mm2 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 mm2 may behave aggressively, and therefore close clinical follow-up is recommended in these cases.
AB - 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 mm2 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 mm2 may behave aggressively, and therefore close clinical follow-up is recommended in these cases.
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U2 - 10.1038/s41379-020-0492-5
DO - 10.1038/s41379-020-0492-5
M3 - Article
C2 - 32051556
AN - SCOPUS:85079729732
SN - 0893-3952
VL - 33
SP - 1410
EP - 1419
JO - Modern Pathology
JF - Modern Pathology
IS - 7
ER -