case_images: PMC10878417_01
case_images: Gastroduodenoscopy showed (A) a cauliflower-like tumor with an ulcer in the cardia. (B) Hematoxylin and eosin staining showed glandular adenocarcinoma gradually transferred from the normal epithelium. High-grade intraepithelial neoplastic was seen with differentiated, moderately differentiated, and poorly differentiated adenocarcinoma. (C) Cells had large round to oval nuclei and coarse chromatin. The degree of mitosis was high (arrow). (D) Immunohistochemical staining revealed that SMARCA4 was lost in tumors while normal epithelium was retained. (E) PanCK, (F) E-cadherin, and (G) SMARCA2 were both positive.
case_images: fonc-14-1297140-g001.jpg
case_images: PMC10878417_01_fonc-14-1297140-g001.jpg
case_images: f1
case_images: Gastroenterology, Zhongshan Hospital of Xiamen University, with a one-month history of indigestion after meals accompanied by pain in the right upper abdomen without any known inducement. Gastroduodenoscopy revealed a cauliflower-like mass with an ulcer in the cardia of the stomach ( Figure 1A ), and a biopsy was performed. There were features of differentiated, moderately differentiated, and poorly differentiated adenocarcinoma ( Figure 1B ). The mitosis index was 15/2 mm2 ( Figure 1C ). None of the tumor expressed SMARCA4 ( Figure 1D ). SALL4, E-cadherin ( Figure 1F ), SMARCB1, and SMARCA2 ( Figure 1G ) were strongly positive. Synaptophysin was weakly positive.
case_images: PMC10878417_02
case_images: Gross appearance showed (A) an elevated solid mass, sized 6.3 cm x 5.1 cm x 1.2 cm in the antrum. (B) Hematoxylin and eosin staining showed the tumor abruptly transferred from the normal epithelium. (C) The tumor encompassed two components with a clear-cut surface. Poorly differentiated adenocarcinoma with gland formation and undifferentiated carcinoma with diffuse sheets without epithelial differentiation. (D) Undifferentiated carcinoma of polygonal cells and pleomorphic giant cells. Rhobdoid cells were common with vesicular nuclei and conspicuous nucleoli. (E) Immunohistochemical staining revealed both areas lost SMARCA4. (F) SMARCA2 was positive in poorly differentiated adenocarcinoma and was reduced in undifferentiated carcinoma. (G) PanCK was positive in poorly differentiated adenocarcinoma and was reduced in undifferentiated carcinoma. (H) E-cadherin was positive in poorly differentiated adenocarcinoma and lost in undifferentiated carcinoma. (I) Vimentin was positive in undifferentiated carcinoma and lost in poorly differentiated adenocarcinoma.
case_images: fonc-14-1297140-g002.jpg
case_images: PMC10878417_02_fonc-14-1297140-g002.jpg
case_images: f2
case_images: The pathological findings revealed an elevated solid mass measuring 6.3 cm x 5.1 cm x 1.2 cm ( Figure 2A ) in the antrum next to the pylorus.Microscopically, the tumor invaded the muscularis propria of the gastric wall. It abruptly transitioned from the normal epithelium ( Figure 2B ). One was a poorly differentiated adenocarcinoma with gland formation ( Figure 2C ). Rhabdoid cells were common; these cells had conspicuous vesicular nucleoli ( Figure 2D ). Both carcinomas lost expression of SMARCA4 ( Figure 2E ) but were positive for SMARCB1, P53, and SALL4. The poorly differentiated adenocarcinoma expressed SMARCA2 ( Figure 2F ), panCK ( Figure 2G ), and E-cadherin ( Figure 2H ) but lost vimentin ( Figure 2I ).