PMC9949736_01
Axial view of computerized tomography imaging. Globally enlarged liver harboring multifocal metastatic GIST, involving both left and right lobes of the liver.. GIST, gastrointestinal stromal tumor. Arrow, multifocal metastatic lesions
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FIG1
From January 2018, the patient continued the care at Mount Sinai Health System with stable lesions on surveillance scans, until July 2020, when hepatic lesions showed an interval increase in size (Figure 1).
(H&E, x20) Liver biopsy showing predominant epithelioid cell type GIST in the background of fibrins and blood clots. The cellular morphology is blend with nuclei with prominent nucleoli and pink cytoplasm.. GIST, gastrointestinal stromal tumor. H&E, hematoxylin and eosin. Arrow, tumor cells
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FIG2
On hematoxylin and eosin (H&E) stain, the tumor cells showed epithelioid clusters with relatively bland nuclear morphology (Figure 2).
Medio-lateral oblique view of right breast mammography showing ovoid dense well-circumscribed lesion.. Arrow, lesion of interest.
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FIG3
Imaging (MRI) showed interval appearance of new multiple peritoneal deposits and enlarged mesenteric lymph nodes, suspicious for metastasis. In May 2022, 14 months post-transplant, on screening mammographic examination, a circumscribed oval, high density 1.0 cm mass was identified from the right breast on 6:00 axis, 6 cm from the nipple (Figure 3).
Breast biopsy showing GIST, confirmed by immunohistochemistry.. A - Hematoxylin and Eosin slide showing pleomorphic epithelioid cell type GIST with atypical mitoses (H&E, x20). B - Diffuse membranous stain of DOG1 seen in the tumor cells (DOG1, x20). C - Diffuse positive stain of the tumor cell with CD117 (c-Kit, x20). D - Non-reactive ER (ER, x20). E - Non-reactive PR (PR, x20). F - Non-reactive GATA3 (GATA3, x20).. H&E, hematoxylin and eosin. GIST, gastrointestinal tumor. DOG1, Discovered On GIST-1. ER, Estrogen receptor. PR, progesterone receptor.
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FIG4
The breast core needle biopsy showed a pleomorphic epithelioid cell-type lesion, with high mitosis (13 mitosis per 5 mm2) and extensive necrosis (Figure 4A). The lesion was diffusely positive for DOG1 and CD117 (and patchy weak positive for CD34) and negative for GATA3, ER and PR, confirming the diagnosis of metastatic GIST morphologically and immunohistochemically (Figure 4B-4F).