A 68-year-old male patient with a history of type 2 diabetes mellitus, insulin-requiring, hypertension for 15 years and ulcerative syndrome under regular medical treatment, with no family history of cancer.
She presented with a 2-month history of food intolerance, progressive postprandial vomiting and weight loss of 8 kg.
Abdominal ultrasound described only vesicular microlithiasis.
High digestive endoscopy showed a large nodular, ulcerated, neoplasic appearance, with massive margins and central necrotic area with necrotic remnants fibrin sealant.
The biopsy concluded a poorly differentiated adenocarcinoma with signet ring cells located in the gastric mucosa.
Helicobacter pylori was not found.
In computed axial tomography of the abdomen, an irregular parietal thickening was described at the level of the upper third of the stomach, with an increase in the density of the cold carial adipose tissue and presence of regional lymph nodes, between 0.6 and 1.2 cm.
The postoperative course was satisfactory, with no evidence of recurrence after 6 months of follow-up.
MATERIALS AND METHODS
The surgical piece was fixed according to the Japanese protocol for gastric cancer, was opened by greater curvature and the perigastric ganglion groups were dissected.
The stomach was stretched in a paraffin wax and fixed in 10% neutral formalin.
The representative samples obtained were embedded in paraffin for histological processing and stained with hematoxylin-eosin (HE), periodic acid-Schiff and alcian blue.
For immunohistochemical analysis, inclusions of paraffin-embedded tissue were selected and cut.
Avidinbiotin complex technique was performed with the antibodies CD34 (Type II, QBEnd/10, NeoMarkers) and CD117 (c-Kit, Policlonal, NeoMarkers).
Diamenobenzidine (DAB) was used as chromogen.
The nuclei were contrasted with hematoxylin.
For the literature review, bibliographic articles were searched and selected, in English and Spanish, from MEDLINE using free terms and MESH, among others: gastrointestinal stromal tumor, neoplasm, stomach neopiasms.
An extra number of publications were obtained from the references of previously selected articles, also using the function "related papers" in MEDLINE and searches in tables of content of pathology, specialized journals, gastroenterology and surgery.
The bibliographic selection only included articles in English or Spanish, with extensive text or full summary.
