GIST Specialist for Hancock Park, CA
GIST is a sarcoma, but it is not like the others. It has a targeted drug that works, and it barely responds to the chemotherapy and radiation used elsewhere in sarcoma. Getting the label right decides which of those you receive. Joshua Ellenhorn, MD, FACS is ten minutes west.
- Confirmation of the GIST diagnosis against its mimics
- Clinical Professor of Surgery, Cedars-Sinai Medical Center
- Slides reviewed by sarcoma pathology within the same institution
- Ten to fifteen minutes along Wilshire or 3rd
GIST Was Only Recognised as Its Own Disease Recently
For most of the twentieth century, tumors arising in the wall of the digestive tract were classified as smooth muscle tumors: leiomyoma if they looked benign, leiomyosarcoma if they did not. That was a reasonable inference from what could be seen under a microscope, and it was wrong.
Around the turn of the century it became clear these tumors arise from an entirely different cell, the interstitial cell of Cajal, and that nearly all carry a mutation in the KIT gene. That discovery did more than rename a disease. It produced a drug. Imatinib was designed to block precisely that mutated signal, and its effect on advanced GIST was dramatic enough to become one of the defining results in modern oncology.
The practical consequence for a patient today is that the label carries treatment implications in both directions. A GIST misclassified as leiomyosarcoma may be given conventional chemotherapy, which works poorly against GIST, while never being offered the targeted drug that would have worked. A leiomyosarcoma misclassified as GIST may be put on imatinib that cannot help it, losing months during which effective treatment was available.
Immunohistochemistry is what separates them, and it is not always completely performed. A report describing a spindle cell tumor without CD117 or DOG1 results has not actually reached a diagnosis.
GIST Against the Tumors It Is Confused With
All of these can arise in or near the digestive tract and several share a similar appearance under the microscope. The treatment differs completely.
| Tumor | How it is identified | How it is treated |
|---|---|---|
| GIST | CD117 and DOG1 positive. Usually a KIT or PDGFRA mutation | Complete surgical removal, and targeted tablets for advanced disease. Chemotherapy and radiation are largely ineffective |
| Leiomyoma | Desmin and smooth muscle actin positive, CD117 negative | Frequently no treatment at all. Benign smooth muscle tumor |
| Leiomyosarcoma | Desmin and actin positive, CD117 negative | Surgery, with conventional chemotherapy and sometimes radiation having a genuine role. Does not respond to imatinib |
| Schwannoma | S100 positive | Benign nerve sheath tumor. Removal if symptomatic, otherwise often left alone |
| Desmoid tumor | Characteristic nuclear beta-catenin staining | Locally aggressive but does not spread. Sometimes observed rather than resected |
| Solitary fibrous tumor | STAT6 positive | Surgery. Behaviour ranges widely and treatment differs from GIST entirely |
| Inflammatory fibroid polyp | Benign, with a PDGFRA mutation in some cases | Benign and generally removed endoscopically if at all |
A report stating spindle cell tumor without immunohistochemistry has described the appearance rather than reached a diagnosis. The stains above are what determine which disease you actually have.
As Sarcomas Go, This Is a Favourable One
Being told you have a sarcoma is frightening, partly because most soft tissue sarcomas genuinely are difficult diseases with limited treatment options. It is worth knowing that GIST occupies an unusual position among them.
Complete surgical removal of a localised GIST with an intact capsule is often curative, and for most gastric tumors that operation is a modest one. Because these tumors rarely involve lymph nodes, the wide clearance other cancers demand is generally unnecessary. Where disease has spread, targeted therapy frequently controls it for years, and there is an established sequence of further drugs when resistance develops. Patients live for a long time with metastatic GIST that is being properly managed.
None of that applies to most other sarcomas, where surgery is often larger, drug options are more limited, and advanced disease is harder to control. If you have been reading general sarcoma material and finding it alarming, a good deal of it does not describe your situation.
The Operations, on Record
Recordings of real GIST resections narrated by the surgeon who performed them. The modest scale of these operations is part of what distinguishes GIST from sarcoma generally.
Laparoscopic Resection of a Gastric GIST
A gastric GIST removed through small incisions with the capsule kept intact.
Gastric GIST Resection: A Simplified Approach
A refined approach that shortens operating time and recovery.
Robotic Resection of a Duodenal GIST
Duodenal GIST removed robotically with the pancreas and bile duct preserved.
Does Yours Name the Stains?
If your pathology says spindle cell tumor, or names a diagnosis without listing CD117 and DOG1 results, the classification has not been confirmed. A review of existing slides settles it without any new procedure.
Certifications and Appointments
Two American Board of Surgery certifications, a Cedars-Sinai teaching appointment, and membership of the Society of Surgical Oncology and the American Society of Clinical Oncology.
- American Board of Surgery, certified in General Surgery
- American Board of Surgery, certified in Colorectal Surgery
- California State Medical License
- Florida State Medical License
Joshua Ellenhorn, MD, FACS
Dr. Ellenhorn is a surgical oncologist and Clinical Professor of Surgery at Cedars-Sinai Medical Center, and a collaborative member of the Samuel Oschin Comprehensive Cancer Institute.
Sarcoma is a category rather than a disease, containing dozens of entities that behave differently and are treated differently. A general surgical oncologist covers the category. This practice concentrates on one member of it, which is what makes it possible to be confident that a tumor is a GIST rather than something adjacent, and to be equally confident when it is not. Sending a patient elsewhere because their tumor turns out to be a leiomyosarcoma is part of the job.
He is certified by the American Board of Surgery in General Surgery and in Colorectal Surgery, a Fellow of the American College of Surgeons, and a member of the Society of Surgical Oncology and the American Society of Clinical Oncology. He practises with the Surgery Group of Los Angeles.
What Patients Say
Reviews left by patients treated by Dr. Ellenhorn at the Surgery Group of Los Angeles.
★★★★★I was very pleased with the office staff, they were always very pleasant and helpful. I was very impressed with Dr. Ellenhorn as well. He was very friendly and addressed all my concerns regarding my surgery and aftercare and follow up.
Terry Jackson
★★★★★Very kind stuff, great service. Dr Joshua Ellenhorn is a very calm doctor who takes time with his patient.
Anita Lukacevic
Ten Minutes From Hancock Park
Third Street west, or Wilshire west and then north, brings you to the medical plaza at 8635 W 3rd St in around ten to fifteen minutes. From the Larchmont and Windsor Square side, Highland south to 3rd and west is equally direct.
The office is attached to Cedars-Sinai Medical Center, and for the diagnostic question on this page that institutional setting is the substance. Distinguishing GIST from leiomyosarcoma or a desmoid tumor is a sarcoma pathology judgement, and having that expertise in the same building means slides can be reviewed and discussed rather than sent away and waited on.
Patients travelling from outside the region, including Arizona and Nevada, can have slides and imaging reviewed remotely.
8635 W 3rd St, Suite 880W
Los Angeles, CA 90048
Monday to Saturday, 11:00am to 8:00pm
Closed Sunday
Frequently Asked Questions
Is GIST the same as leiomyosarcoma?
Why does the distinction matter so much?
Does chemotherapy work for GIST?
What about radiation?
How do pathologists tell these tumors apart?
Is GIST considered a better diagnosis than other sarcomas?
What if my report says spindle cell tumor without more detail?
How far is your office from Hancock Park?
Confirm It Is a GIST Before Accepting Sarcoma Treatment.
Chemotherapy and radiation work poorly against GIST while targeted therapy works well. The immunohistochemistry on your pathology report is what determines which you should be receiving.
