GIST Specialist for Playa Vista, CA
A second opinion on a gastrointestinal stromal tumor is only as good as the material it is based on, and most patients arrive with a summary rather than the actual data. Joshua Ellenhorn, MD, FACS reviews the imaging itself. Here is how to get hold of yours.
- Review of the imaging study, not just the radiology report
- Clinical Professor of Surgery, Cedars-Sinai Medical Center
- Pathology slides requested from the originating laboratory
- Twenty five to thirty minutes via Jefferson and La Cienega
Most Second Opinions Are Given on Incomplete Information
Patients arrive for a specialist opinion carrying a folder. Usually it contains a radiology report, a clinic letter, and sometimes a pathology summary. What it very often does not contain is the imaging itself, and that gap quietly limits what the consultation can achieve.
A radiology report is an interpretation written to answer a particular question at a particular moment. It states what was looked for and found. It does not state what nobody was asking about, and for a surgical decision the relevant detail is frequently exactly that. Whether a duodenal tumor abuts the pancreas or merely lies near it. How many millimetres separate a rectal tumor from the sphincter. Whether a liver lesion visible now was present on a study from two years ago. None of those questions is answerable from text.
The same applies to pathology. A report gives a diagnosis and, if you are fortunate, a mitotic index. The slides themselves allow a sarcoma pathologist to confirm the diagnosis, look for the immunohistochemistry that distinguishes GIST from its mimics, and assess features the original report did not comment on.
All of this material is yours and you are entitled to it. The practical obstacle is simply that nobody tells patients how to ask, so most do not.
What to Request, From Whom, and Why
Start these requests before you have decided where to be seen. Nothing here depends on committing to a particular practice.
| What to request | Who holds it | Why it matters |
|---|---|---|
| Imaging studies in DICOM format | The imaging or medical records department of the facility that scanned you | Contains the detail a report omits. Ask for the study itself, on disc, USB or portal download, not a printed summary |
| All prior imaging, not just the latest | Same, though older studies may be archived | Comparison against previous scans is how stability is established and how false alarms are avoided |
| Full pathology report | The laboratory that processed the specimen | Should include the mitotic index and immunohistochemistry. Note the accession number printed on it |
| Mutation testing report | Often a separate molecular laboratory | Determines which drug works and at what dose. Frequently a separate document that never reaches the patient |
| Pathology slides or blocks | The originating laboratory, released using the accession number | Allows an independent review of the diagnosis without any new procedure |
| Operative report | Medical records at the hospital where surgery was performed | States what was removed and whether the capsule was intact, which determines your risk category |
| Endoscopy and EUS reports | The performing gastroenterologist or facility | Describes what was seen and whether the lesion was sampled, and how |
If you cannot obtain something, send what you have. The office can request records and slides directly from another institution on your behalf, which is often faster than doing it yourself.
Why the Detail Changes the Decision
GIST arises from the interstitial cells of Cajal, the pacemaker cells inside the wall of the digestive tract that coordinate the contractions moving food along. It is a sarcoma rather than a carcinoma, and one consequence is that the surgical margin required is narrow. Complete removal with an intact capsule is what constitutes a cure, and the wide clearance a stomach or bowel cancer would demand is generally unnecessary.
That is precisely why the fine detail on imaging matters so much. When the required margin is narrow, the question of whether a tumor can be removed while preserving the pancreas, the sphincter, or most of the stomach turns on a few millimetres of anatomical relationship. Those millimetres decide whether you have a modest operation or a major one, and they exist in the images rather than the report.
Risk grading works the same way. Size, site and mitotic index produce a category that determines whether you need years of medication. Two of the three come from pathology, and the mitotic index in particular is a number that is either in the report or is not. Where it is missing, the slides can supply it.
What Good Planning Produces
Recordings of real GIST resections narrated by the surgeon who performed them. Operations this contained depend on knowing the anatomy precisely beforehand.
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, which is a decision made from imaging before the first incision.
Request the Study, Not the Summary
One phone call to the imaging department, and one to the pathology lab with your accession number. It costs nothing and it is the difference between a specific surgical opinion and a general one.
Certifications and Appointments
Two American Board of Surgery certifications, a Cedars-Sinai teaching appointment, and membership of the societies that set the standards for this disease.
- 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.
He reviews the imaging and pathology himself rather than working from a summary prepared by someone else. That sounds like a small thing and it is the reason a second opinion is worth having at all. An opinion built on another clinician interpretation is not independent, it is an endorsement, and for a tumor where the operation hinges on a few millimetres of anatomy it adds very little.
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
★★★★★The staff at the Surgery Group of Los Angeles are wonderful. They are kind, very attentive, the office is clean and I did not have to wait long at all. I cannot say enough great things about Dr. Ellenhorn. He is an excellent surgeon who is highly skilled and very knowledgeable. I cannot thank him enough for all he has done for my family and I.
Erika Frank
From Playa Vista
Jefferson or Culver Boulevard east to La Cienega and north, then east along 3rd Street, is the usual route and tends to be the more predictable. The 90 to the 405 north and the 10 east is quicker off peak. Twenty five to thirty minutes depending on the hour.
The office is in the medical plaza attached to Cedars-Sinai Medical Center, where imaging and pathology are in the same building as the consultation. Practically that means a study you bring on disc can be loaded and reviewed alongside anything performed here, and slides requested from another laboratory can be read by a sarcoma pathologist in the same institution.
Patients travelling from outside the region, including Arizona and Nevada, can have the whole review done remotely once the file is assembled.
8635 W 3rd St, Suite 880W
Los Angeles, CA 90048
Monday to Saturday, 11:00am to 8:00pm
Closed Sunday
Frequently Asked Questions
Am I entitled to my own imaging, not just the report?
Why does the actual scan matter more than the report?
What is DICOM?
Can I get my pathology slides too?
What is an accession number?
How long do records requests take?
Should I keep my old scans after treatment?
How far is your office from Playa Vista?
Bring the Data, Not the Summary.
Your imaging in DICOM format, the full pathology report with its accession number, the mutation testing, and any operative report. That file is what turns a general opinion into a specific one.
