case_images: PMC11835082_01
case_images: (A) A raised lesion about 1.8 cm x 1.5 cm in size was seen in the middle of the gastric body, with surface flushing. (B) FICE observed the lesion boundary was clear, and branched dilated blood vessels were seen on the surface. (C) ESD of gastric body. ESD = endoscopic submucosal dissection, FICE = flexible spectral imaging color enhancement.
case_images: medi-104-e41575-g001.jpg
case_images: PMC11835082_01_medi-104-e41575-g001.jpg
case_images: F1
case_images: A 61-year-old male, was admitted to the outpatient clinic for "abdominal discomfort for 1 month." Gastroscopy showed multiple small polyps in the gastric body and fundus, and a raised lesion approximately 1.8 x 1.5 cm in size was seen in the middle of the gastric body, with surface flushing (Fig. 1A). Flexible spectral imaging color enhancement revealed that the lesion boundary was clear and branched dilated blood vessels were observed on the surface (Fig. 1B). Postoperative pathological macroscopic findings: ESD of gastric body: a piece of mucosal tissue, 1.88 x 1.5 cm in size, a flat bulge mass on the mucosal surface, 1.78 x 1.4 cm in range, 0.3 cm higher than the mucosal surface, close to the incision margin (Fig. 1C); Microscopic findings: hyperplasia of oxyntic glands, mainly proliferation of main cells, scattered parietal cells (Fig. 2A), complex glandular structure, atypia of cells, and some areas break through the mucous muscle and infiltrate the submucosa (Fig. 2B).
case_images: (A) Hyperplasia of oxyntic glands, mainly proliferation of main cells, scattered parietal cells. (B) Complex glandular structure, atypia of cells, and some areas break through the mucous muscle and infiltrate the submucosa. (C) Elastic fiber staining revealed vessels. (D) MSH2 (+). (E) MSH6 (+). (F) MLH1 (+). (G) PMS2 (+). (H) MUC2 (-). (I) MUC5AC (-).
case_images: medi-104-e41575-g002.jpg
case_images: PMC11835082_01_medi-104-e41575-g002.jpg
case_images: F2
case_images: Postoperative pathological macroscopic findings: ESD of gastric body: a piece of mucosal tissue, 1.88 x 1.5 cm in size, a flat bulge mass on the mucosal surface, 1.78 x 1.4 cm in range, 0.3 cm higher than the mucosal surface, close to the incision margin (Fig. 1C); Microscopic findings: hyperplasia of oxyntic glands, mainly proliferation of main cells, scattered parietal cells (Fig. 2A), complex glandular structure, atypia of cells, and some areas break through the mucous muscle and infiltrate the submucosa (Fig. 2B). MSH2 (+; Fig. 2D), MSH6 (+; Fig. 2E), MLH1 (+; Fig. 2F), PMS2 (+; Fig. 2G), MUC2 (-; Fig. 2H), MUC5AC (-; Fig. 2I), CDX-2 (-), Her-2 (-), CD31, and D2-40 showed vasculature, desmin showed mucosal muscle, P53 (wild type), Ki-67 (+, 3%), and Hp (-). Special staining: Elastic fiber staining revealed the vessels (Fig. 2C).