The most critical parameters for each mast cell tumor after excision are grade and margins. Grade II tumors tend to be the most difficult to interpret based on the historical wide range of behavior. If a tumor is determined to be a grade II tumor, mitotic index, Ki-67, and KIT should be determined to differentiate grade II-low (less aggressive and more similar in behavior to a grade I) from grade II-high (more aggressive and similar in behavior to a grade III). For grade II-low tumors, they can follow a similar treatment plan as grade I tumors. [Figure 3] Grade II-high and grade III tumors should have KIT staining and KIT mutation status determined as it affects adjuvant treatment strategy and prognosis. KIT mutation positive would likely be started on Palladia treatment whereas KIT mutation negative would likely be started on vinblastine and prednisone. Colorado Statue University and Michigan State University have comprehensive mast cell tumor panels that tests for mitotic index, Ki-67, KIT IHC staining, and KIT mutation status. AgNOR and p53 can also be performed but in the author’s opinion they are not necessary if grade, margins, stage, mitotic index, Ki-67, and KIT mutation status are available.
He was tall; but you only perceived it when he was standing by the side of others, for the great breadth of his shoulders and chest made him appear but little above the middle height. His chest was as deep as it was wide; his arm like that of Hercules; and his hand “the fist of a tar—every hair a rope-yarn.” With all this he had one of the pleasantest smiles I ever saw. His cheeks were of a handsome brown; his teeth brilliantly white; and his hair, of a raven black, waved in loose curls all over his head, and fine, open forehead; and his eyes he might have sold to a duchess at the price of diamonds, for their brilliancy…Take him with his well-varnished black tarpaulin stuck upon the back of his head; his long locks coming down almost into his eyes; his white duck trousers and shirt; blue jacket; and black kerchief, tied loosely round his neck; and he was a fine specimen of manly beauty… His strength must have been great, and he had the sight of a vulture. It is strange that one should be so minute in the description of an unknown, outcast sailor, whom one may never see again, and whom no one may care to hear about; but so it is. Some people we see under no remarkable circumstances, but whom, for some reason or other, we never forget. He called himself Bill Jackson… .