Skip to main content

Archived Comments for: Gastrointestinal autonomic nerve tumours – report of a case and review of literature

Back to article

  1. Is Digestive tract (Gastrointestinal) Schwannoma part of Gastrointestinal Autonomic Nerve Tumour (GANT)?

    Aftab Khan, Department of General Surgery, Queen Mary Sidcup Hospital, London United Kingdom

    7 July 2006

    Comment:

    Is Digestive tract (Gastrointestinal) Schwannoma part of Gastrointestinal Autonomic Nerve Tumour (GANT)?

    Mr. A Khan, MD MRCS

    Dr. G K Azad, MD

    Recent extensive work by Fletcher et al [I] on Gastrointestinal Stromal Tumors and Prevot et al [II] on Digestive Tract Schwannoma (DTS) has lead to interesting conclusions.

    Gastrointestinal stromal tumours (GISTs) are Gastrointestinal mesenchymal tumours (GIMTs) expressing KIT protein (CD117). These tumours are derived from interstitial cell of Cajal. These cells have features of both smooth muscle and neuronal differentiation. Gastrointestinal autonomic nerve tumours (GANTs) represent neuronal differentiation of GIST. On the other hand Digestive tract schwannoma (DTS) are GIMT arising from Schwann cells of the neural plexus of the digestive wall. It lacks KIT mutation and KIT protein (CD117) expression.

    Histological ultra-structural studies show that GANT are made up of either spindle cells or epitheliod cells with usually no associated inflammatory cells or peripheral lymphoid cuffing. The later is a typical feature of DTS which are usually composed of only spindle cells . Moreover skeniod fibres (previously thought to correlate with neuronal differentiation of GIST) are found in some GANTs but never in DTS.

    GANT has variable immunohistochemical profile and diagnosis is based on ultrastructural features. On the other hand DTS express always S-100 protein and GFAP.

    Lastly, GANT have an aggressive clinical course with high recurrence rate whereas DTS are benign tumours with no long-term recurrence reported after surgical resection.

    In conclusion, GANT and DTS are two different but distinct entities. Distinction is important from clinical perspective with regards to onco-surgical planning and follow-up.

    Competing interests

    None of the authors have any competing interests

Advertisement