Distinct clinical, laboratory, molecular, and pathologic features of systemic mastocytosis involving the gastrointestinal tract.

OBJECTIVE

Gastrointestinal (GI) symptoms are common in systemic mastocytosis (SM). We hereby report the clinicopathologic and molecular features of GI mastocytosis.

METHODS

The study includes 104 patients with suspected SM. Of 258 GI biopsy -specimens, 33 (20 patients, 19%) were mastocytosis-positive, with 19 (16 patients) initially missed.

RESULTS

Tryptase (n = 29) was weakly positive/negative in two-thirds of the mastocytosis-positive GI biopsy specimens. Additional immunohistochemistry (n = 23) showed positive mast cell expression for CD30 (n = 2), CD123 (n = 7), and PD-L1 (n = 12), as well as increased PD-1-positive cells (n = 4). Sixty patients had positive bone marrow (BM) for SM (SM-BM+), including 19 with positive GI biopsy specimens (SM-GI+). Almost all (43/44) SM-BM- patients were SM-GI-. The SM-GI vs SM-BM status showed high positive predictive value (95%) and specificity (98%). Patients with SM with mastocytosis-positive vs mastocytosis-negative GI biopsy specimens had higher serum tryptase levels (P = .04). KIT D816V mutation was detected in 7 of 13 and 12 of 13 mastocytosis-positive GI biopsy specimens using allele-specific polymerase chain reaction and droplet digital polymerase chain reaction (ddPCR), respectively.

CONCLUSIONS

GI mastocytosis is highly predictive of SM in BM; however, most SM-BM+ patients are SM-GI-. The SM-BM- patients are very unlikely to be SM-GI+. Because GI neoplastic mast cells are often tryptase negative, diagnostic evaluation should include CD117 and CD25 immunohistochemistry, as well as KIT D816V mutation analysis by ddPCR as needed.