case_images: PMC7101478_01
case_images: CT Abdomen with IV Contrast. The coronal image of contrast-enhanced CT scan revealed that the lesion was within normal limits, and the gastric wall was poor filling.. On transverse, the intestinal tract is normal. There was no sign of ileus.. CT= Computed Tomography; IV= intravenous
case_images: med-15-225-g001.jpg
case_images: PMC7101478_01_med-15-225-g001.jpg
case_images: j_med-2020-0033_fig_001
case_images: The CT results were within normal limits (Fig.1).
case_images: Endoscopic performance. A. A submucosal protuberant lesion in the gastric antrum with well-defined borders.. B. Surface microstructure and microvascular patterns were regular. Its surface appearance was similar to that of the surrounding normal tissue. There seemed to be a slight depression in the center of the lesion. The glands were slightly dense.. C. A hypoechoic tumor with slightly heterogeneous internal echoes originating from the submucosal area located at the gastric antrum.. D. Pathological tissue obtained by ESD, which was a yellow oval tissue measuring 1.3*1.0 cm.. ESD= Endoscopic submucosal dissection
case_images: med-15-225-g002.jpg
case_images: PMC7101478_01_med-15-225-g002.jpg
case_images: j_med-2020-0033_fig_002
case_images: The EUS indicated a hypoechoic tumor with slightly heterogeneous internal echoes originating from the submucosal area located at the stomach antrum, measuring 1.3*1.0 cm with well-defined borders (Fig.2A BC). The tumor protruded into the cavity. Upon ESD, we could see a yellow oval tissue with a well-defined border that was similar to fat or pancreatic lesions (Fig.2D).
case_images: Histopathologic and immunohistochemical expression of pathological tissue.. HEx400. The tumor cells demonstrated fusiform, vortex-like and onion-like hyperplasia around the blood vessels, there were some eosinophils and lymphocytes, and a small number of plasma cells infiltrated the stroma.. CD34. Immunohistochemical findings revealing spindle cells stained positive for CD34(tumor cells +) x 400.. SMA. Immunohistochemical findings revealing spindle cells stained positive for SMA (tumor cells +) x 400.. CD117. Immunohistochemical stain for CD117 shows negative in the lesional cells(tumor cells +) x 400.. DOG-1. Immunohistochemical stain for DOG-1 shows negative in the lesional cells(tumor cells +) x 400.. S100. Immunohistochemical stain for S100 shows negative in the lesional cells(tumor cells +) x 400.. ALK. Immunohistochemical stain for ALK shows negative in the lesional cells(tumor cells +) x 400.. P53. The P53 labeling index was 1%(tumor cells +) x 400.. Ki-67. The Ki-67 labeling index was 5% in the spindle cells(tumor cells +) x 400.. HE= Hematoxylin-eosin staining, SMA= SmoothMuscle Actin
case_images: med-15-225-g003.jpg
case_images: PMC7101478_01_med-15-225-g003.jpg
case_images: j_med-2020-0033_fig_003
case_images: Histopathologic analysis indicated an onion-skin-like concentric formation of the fibroblastic stroma and spindle cells with inflammatory cell infiltration, predominantly by numerous eosinophils (Fig.3A). Immunohistochemical examination showed that the cells were positive for CD34 (Fig.3B), Smooth Muscle Actin (SMA) (Fig.3C), and were negative for CD117 (Fig.3D), DOG-1 (Fig.3E), S100 (Fig.3F) and ALK (Fig.3G). The P53 labeling index was 1% (Fig.3H), whereas the Ki-67 labeling index was 5% in the spindle cells (Fig.3I).