Small bowel (small intestine)
Other malignancies
Malignant gastrointestinal neuroectodermal tumor

Author: Raul S. Gonzalez, M.D.

Revised: 22 November 2017, last major update November 2017

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: "Malignant gastrointestinal neuroectodermal tumor"

Cite this page: Gonzalez, R.S. Malignant gastrointestinal neuroectodermal tumor. PathologyOutlines.com website. http://pathologyoutlines.com/topic/smallbowelmaliggastroneuroectodermaltumor.html. Accessed December 15th, 2017.
Definition / general
  • Rare malignant mesenchymal neoplasm of the gastrointestinal tract
Essential features
  • Mesenchymal malignancy that grows in sheets or cords and may have osteoclast-like giant cells
  • Positive for S100 and synaptophysin; negative for HMB45 and MelanA
  • Harbors EWSR1 translocation
Terminology
  • Also known as clear cell sarcoma-like tumor of the gastrointestinal tract
Sites
Clinical features
  • Median age 35 years; no sex predilection (Arch Pathol Lab Med 2015;139:407)
  • Most common symptoms are abdominal pain and intestinal obstruction
  • Tumor can spread to lymph nodes and liver and may cause death
Case reports
Treatment
  • Surgery; possible adjuvant role for c-Met / ALK inhibitors and VEGF inhibitors (Oncology 2016;91:348)
Gross description
  • Large mass (mean 5 cm)
Gross images

Images hosted on other servers:

Cross section of small bowel tumor

Microscopic (histologic) description
  • Sheets or nests of oval / spindled mesenchymal cells with clear or eosinophilic cytoplasm, visible nucleoli and often mitoses
  • Osteoclast-like giant cells may be seen
  • Tumor often spans the entire wall
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Raul S. Gonzalez, M.D.

Low power

Intermediate power

High power

Positive stains
Negative stains
Electron microscopy description
  • Secretory vesicles and dense core granules
Molecular / cytogenetics description
  • Translocation involving EWSR1 (most commonly EWSR1-ATF1 [t(12;22)] or EWSR1-CREB1)
Differential diagnosis
Additional references
Board review question #1
Which of the following is true about malignant gastrointestinal neuroectodermal tumor?

  1. It can demonstrate a t(12;22) EWSR1-ATF1 translocation
  2. It most commonly occurs in the colon
  3. Its preferred site of metastasis is the lungs
  4. It stains positive for S100 and cytokeratin by immunohistochemistry
  5. Most patients are in their sixth decade or older
Board review answer #1
A. It can demonstrate a t(12;22) EWSR1-ATF1 translocation