case_images: PMC10562619_01
case_images: Images of abdominal computed tomography and 3D visualization reconstruction, macroscopic specimen after multivisceral resection. (A) plain scan; (B) arterial phase; (C) venous phase; (D) coronary scan; (E) visualization reconstruction; (F) postoperative specimen.
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case_images: The patient underwent an abdominal contrast-enhanced computed tomography (CT) scan, as follows ( Figures 1A-D ): there was a 8.1x6.0x7.9 cm solid mass of the left adrenal gland involving the pancreatic tail, serosal surface of the gastric fundus, and spleen with splenic infarction. CT image data stored in the form of DICOM was imported into Yorktal 3D+Visualization System for 3D visualization reconstruction ( Figure 1E ). Finally, the patient received retroperitoneal tumor resection, partial gastrectomy, pancreatectomy, splenectomy, left nephrectomy, partial colon resection, and enucleation of liver metastases ( Figure 1F ).
case_images: Pathological findings. (A-C) HE and immunohistochemical staining of tumor puncture tissue in the left adrenal region: (A) HE staining suggested tumor cell showed a nest-like distribution, neoplastic cells with polygonal shape, abundant and acidophilic cytoplasm, mile nuclear atypia without necrosis, rare nucleoli; (B). CgA (+); (C). Ki-67 (10%). (D-F) HE and immunohistochemical staining of gastric fundus tumor tissue: (D) HE staining showed the microscopic characteristics of tumor cells were similar to A; (E) CgA (+); (F) Ki-67 (20%). (G-I) HE and immunohistochemical staining of postoperative tumor tissue: (G) HE staining suggested tumor cell showed nest-like and cord-like distributions, neoplastic cells with polygonal shape, abundant and acidophilic cytoplasm, mild-to-moderate nuclear atypia with massive necrosis, obvious nucleoli; (H). CgA (+); (I) Ki-67 (40%).
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case_images: Hematoxylin and eosin (HE) staining of two specimens both suggested tumor cells showed a nest-like distribution, neoplastic cells with polygonal shape, abundant and acidophilic cytoplasm, mile nuclear atypia without necrosis, and rare nucleoli ( Figures 2A, D ). Immunohistochemistry staining revealed that the tumor cells were positive for chromogranin A (CgA) ( Figures 2B, E ), synaptophysin (Syn), cytokeratin 18 (CK18) and negative for inhibin, CEA, calretinin, epithelial membrane antigen (EMR), vimentin, Melan-A, Pax-8, SF-1, P53, S-100. The Ki-67 index was 10% in the specimen of the adrenal lesion ( Figure 2C ) and 20% in the specimen of the gastric fundus ( Figure 2F ). The pathological diagnosis of surgical specimens was as follows: HE staining suggested tumor cell showed nest-like and cord-like distributions, neoplastic cells with polygonal shape, abundant and acidophilic cytoplasm, mild-to-moderate nuclear atypia with massive necrosis, obvious nucleoli ( Figure 2G ). TTF1, CT, Pax-8, CDX2. The Ki-67 index was 40% in the specimen ( Figure 2I ).
case_images: Immunohistochemistry of PD-L1 protein in puncture pathological tissues from Beijing ACCB Biotech Ltd. (A) microscopic image of puncture pathological tissue: TPS=20%, CPS=23; (B) positive control: TPS >=1%.
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case_images: Detection of the PD-L1 protein expression showed that the tumor proportion score (TPS) was 20% and the combined positive score (CPS) was 23 ( Figure 3 ).