case_images: PMC9937071_01
case_images: CT scan showing gastric perforation (red arrow) and pneumoperitoneum in (a): axial section and (b): sagittal section.
case_images: can-17-1498fig1.jpg
case_images: PMC9937071_01_can-17-1498fig1.jpg
case_images: figure1
case_images: An abdominal computed tomography (CT) scan was then requested, evidencing pneumoperitoneum and gastric mucosal enhancement with a clear stop in continuity in the greater curvature prior to the antropyloric junction with no other abnormal findings (Figure 1a and b).
case_images: Exploratory laparoscopy evidencing massive perforation of the anterior wall of the gastric antrum.
case_images: can-17-1498fig2.jpg
case_images: PMC9937071_01_can-17-1498fig2.jpg
case_images: figure2
case_images: Exploratory laparoscopy was performed evidencing a 4-quadrant peritonitis secondary to a 5 cm perforation at the antropyloric junction caused by a necrotic malignant tumour (Figure 2).
case_images: Resected specimen evidencing an ulcerated whitish tumour of 5.6 x 3.8 cm. The lesion involved and perforated the gastric wall with extension into the serosa.
case_images: can-17-1498fig3.jpg
case_images: PMC9937071_01_can-17-1498fig3.jpg
case_images: figure3
case_images: The lesion involved and perforated the gastric wall with extension into the serosa (Figure 3).
case_images: (a): Histological section (H&E - Magnification 40x). The left portion of the image shows mucosal ulceration with a dense tumour cell infiltration underneath. The right half shows adjacent mucosa with expansion of lamina propria by medium-to-large size moderately pleomorphic cells. (b): Histological section (H&E - Magnification 400x) Neoplastic T cells form a dense, moderately pleomorphic infiltrate, medium to large in size with round or angled nuclei and prominent nucleoli. Frequent mitotic figures are observed. There is a component of inflammatory cells, including histiocytes and eosinophils.
case_images: can-17-1498fig4.jpg
case_images: PMC9937071_01_can-17-1498fig4.jpg
case_images: figure4
case_images: The histological sections of material, embedded in paraffin and coloured with haematoxylin and eosin, showed a neoplastic proliferation of diffuse medium to large cells with abundant cytoplasm and round or angulated nuclei, accompanied by a pronounced and polymorphic inflammatory background and extensive areas of necrosis (Figure 4).
case_images: Immunostaining results.
case_images: can-17-1498fig5.jpg
case_images: PMC9937071_01_can-17-1498fig5.jpg
case_images: figure5
case_images: Staining for CD30, CD4, CD5, CD56, anaplastic lymphoma kinase-1 and keratin cocktail (AE1AE3) as well as B-cell differentiation markers (CD20, PAX5 and CD138) was found to be negative (Figure 5).