Gastrointestinal Imaging

Stromal cell tumour, gastrointestinal

common name given to submucosal tumours arising from supportive tissue. Immunohistochemical or electron microscopic studies are often needed to determine if a given stromal tumour is composed specifically of neoplastic smooth muscle cells, neuroendocrine or vascular elements. Only 1% of the tumours of the gastrointestinal tract are of stromal cell origin. They occur most frequently in the stomach and small bowel, less frequently in the colon and oesophagus.

It is difficult to determine whether stromal cell tumours are benign or malignant on the basis of their histological appearance alone. It has recently be recognized that most CD 34 positive gastrointestinal stromal tumours are neither typical smooth muscle nor neural tumours. CD 34 appears to stain a group of fibroblast-like and neural cells primarily in the myenteric plexus corresponding to the interstitial cells of Cajal ( ICC), the putative pacemaker cells of the gut. Most gastrointestinal stromal tumours arise from the ICCs. These tumours thus may be divided into those of ICC, smooth muscle and neural origin. Other authors propose to replace the term gastrointestinal stromal tumour by that of GI-pacemaker cell tumour or GI-PACT.

Stromal tumours have the same appearance as other submucosal tumours and are characterized by the abrupt angle that they form with the bowel wall and by their smooth margin and surface (Fig.1).

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Fig.1

Stromal cell tumour of the stomach. There is a small tumour (diameter 2 cm) (arrow) arising from the ventral wall of the fundus of the stomach.
Stromal cell tumour, gastrointestinal, Fig.1