CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors

The large majority of gastrointestinal stromal tumors (GIST) can be diagnosed on the basis of KIT immunoreactivity. However, some atypical tumors show weak or negative KIT expression. We studied the imaging characteristics of atypical GIST, reviewing CT and MRI findings in ten patients (eight men, two women; mean age 59 years) with atypical GIST. Radiological studies were evaluated by two radiologists by consensus and included CT and MR imaging in all patients. Pathological diagnoses were made from surgery and confirmed by the polymerase-chain reaction (PCR) to amplify both exons of the c-kit gene and PDGFRA gene. The CT and MR examinations revealed a heterogeneous mass of the stomach containing cystic regions and soft tissue elements in all cases. All lesions were extraluminal masses and had an exophytic epicenter. On T1-weighted MR images soft tissue elements of the tumors were of homogeneously low- (n=3) or iso-signal intensity (n=7) compared with the liver parenchyma. On fast spin-echo T2-weighted MR images soft tissue elements of all tumors showed cystic regions of significantly high signal intensity interspersed with septumlike structures of low signal intensity. All lesions exhibited homogeneously (n=4) or heterogeneously (n=6) mild to moderate enhancement of soft tissue elements. Despite the relatively small number of patients CT and MRI findings of atypical GIST are a submucosal mass with soft tissue elements and cystic regions.