Clinicopathologic spectrum of gastro intestinal stromal tumours - Experience at a tertiary care center.

Context: Accurate diagnosis of Gastrointestinal stromal tumors (GISTs) and categorization of risk groups is crucial in the wake of targeted drug therapy. Aim: This study was undertaken to obtain insight into the clinicopathologic features of GISTs. Materials and Methods: Retrospective study of 20 cases of c-KIT (CD 117) positive GISTs .Various histologic parameters were studied. Immunohistochemical panel included CD-34, Smooth muscle actin, S-100, Desmin, and Vimentin. Risk categorization was done as per standard protocol. Clinical details and follow up were retrieved from cases files. Results: Of the total 20 cases, 15 were males. The mean age of presentation was 52 years. 50 % of the cases presented with gastro intestinal bleeding .The cases were categorized as high risk (60%), intermediate risk (20%), low risk (15%) and very low risk (5%). Stomach and small intestine were commonly involved and in 6 of the cases there were metastatic nodules in the mesentery/omentum/ peritoneum. Spindle cell morphology was the commonest histological pattern (55%). Nuclear pleomorphism, perivascular whorling, mucosal and fat invasion were seen only in the high risk group. CD-34, SMA and S-100 were positive in 90%, 30%, and 10% of the cases, respectively, with consistent Desmin negativity. Conclusions: Cases of GISTs in our clinical setting presented a decade earlier and mostly belonged to the high risk group. Certain histological features such as necrosis, and perivascular whorling were more commonly associated with the high risk groups.

The bone marrow in Hodgkin's disease--a two year study.

A total of forty bone marrow trephine biopsies and aspirates were studied from thirty five patients suffering from Hodgkin's disease during the two year period 1994 and 1995. Of these twenty five were at the time of diagnosis of the disease and fifteen after treatment. The biopsies were studied for incidence of involvement as well as associated findings in both the positive and negative biopsies. A comparison of the trephine biopsy with marrow aspirate with respect to yield of positivity was made. Five patients (20%) at the time of diagnosis and two (13.33%) after treatment showed involvement of the marrow. None of the seven corresponding aspirates were positive for involvement showing that biopsies were superior to aspirates in detecting marrow infiltration in Hodgkin's disease. Suppression of the marrow, fibrosis and lymphocytic aggregates were the other findings in positive biopsies. Eosinophilia and myelosuppression were notable changes in the negative biopsies. One biopsy also showed granulomas. The probable significance of these findings are also discussed.