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Keratin-positive Gastrointestinal Stromal Tumor of the Stomach Mimicking Gastric Carcinoma: Diagnosis Confirmed by c-kit Mutation Analysis

Lippai, Norbert MD*; Füle, Tibor PhD; Németh, Tamás MD*; Benedek, György MD; Mályi, Imre MD§; Pádi, Éva MD; Sápi, Zoltán MD, PhD

Diagnostic Molecular Pathology: December 2008 - Volume 17 - Issue 4 - pp 241-244
doi: 10.1097/PDM.0b013e31816184c6
Case Report
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In routine practice, gastrointestinal stromal tumor (GIST) can usually be identified with relative ease on the basis of a rather simple immunohistochemical panel besides its characteristic morphology. Still, serious differential diagnostic problems may arise because of the heterogeneity of these tumors in both morphologic appearance and clinical behavior. In our case, we present a metastatic, ulcerative, hemorrhagic GIST with epithelioid appearance, which displayed diffuse pan cytokeratin (AE1/AE3) positivity beside CD117 expression. As carcinomas may also be CD117-positive, definitive diagnosis was confirmed by the detection of a hexanucleotide deletion in the exon 11 of c-kit. This case demonstrates that although gastric carcinoma more commonly ulcerates or causes hemorrhage than GIST, keratin-positive GIST should also be considered from a differential diagnostic point of view. In these cases, c-kit mutation analysis may be necessary.

Departments of *Pathology

Surgery

§Gastroenterology

Oncology, Bajcsy Zsilinszky Hospital

1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary

Reprints: Zoltán Sápi, MD, PhD, Üllői út 26, 1085 Budapest, Hungary (e-mail: zsapi@freemail.hu).

© 2008 Lippincott Williams & Wilkins, Inc.