case_images: PMC9035921_01
case_images: a Upper gastrointestinal endoscopy revealed the presence of a SMT approximately 1 cm in size with a delle in the anterior wall of the gastric body. The tumor surface was covered with normal gastric mucosa, and the content of the tumor was hard. b EUS revealed a 1-cm tumor in the submucosal layer of the stomach. c, d Enhanced computed tomography showed that the tumor was hypervascular in the arterial phase (c), with continuous enhancement in the post-venous phase (d).
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case_images: PMC9035921_01_crg-0016-0159-g01.jpg
case_images: F1
case_images: Upper gastrointestinal endoscopy revealed the presence of a SMT with a delle in the greater curvature of the lower body of the stomach (Fig. 1a). On endoscopic ultrasonography (EUS), the tumor had a low echo pattern and an irregular shape and was located in the submucosal layer of the stomach (Fig. 1b). Contrast-enhanced computed tomography (CECT) of the abdomen showed that the gastric tumor was hypervascular in the arterial phase (Fig. 1c) and exhibited continuous enhancement in the post-venous phase (Fig. 1d).
case_images: The NEWS procedure. a The circumferential of the tumor was marked during upper gastrointestinal endoscopy. b A sero-muscular incision from the outside of the stomach was made during laparoscopy. c A muco-submucosal incision from the inside of the stomach was made during upper gastrointestinal endoscopy. d The resected specimen is shown.
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case_images: PMC9035921_01_crg-0016-0159-g02.jpg
case_images: F2
case_images: NEWS (Fig. 2a-d); the operative time was 214 min. No adverse events occurred during or after the operation, and the patient was discharged 6 days after NEWS.
case_images: Microscopic analysis of the tumor specimen. a Hematoxylin and eosin staining showing a proliferation of spindle-shaped tumor cells in the submucosa (original magnification, x2). b Hematoxylin and eosin staining showing the spindle-shaped tumor cells at a higher magnification (original magnification, x400). c Immunohistochemical examination revealed D2-40 positivity in the tumor cells (original magnification, x400). d Immunohistochemical examination revealed aSMA positivity in the tumor cells (original magnification, x400). e-w Immunohistochemical examination revealed c-kit, discovered on GISTs, desmin, S100, Melan-A, signal transducer and transactivator 6, insulinoma-associated protein 1, CXCL13, ETS transcription factor, follicular dendritic cell, anaplastic lymphoma kinase, CD1a, 10, 21, 23, 31, 34, 68, and 163 negatively in the tumor cells (original magnification, x400). x Approximately, 1-2% of the tumor cell nuclei expressed Ki-67 (original magnification, x400). GIST, gastrointestinal storomal tumor.
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case_images: PMC9035921_01_crg-0016-0159-g03.jpg
case_images: F3
case_images: Microscopic examination revealed a proliferation of tumor cells with spindle-shaped nuclei in the submucosa (Fig. 3a, b). Immunohistochemical examination revealed that the tumor was positive for D2-40 (Fig. 3c) and alpha-smooth muscle actin (Fig. 3d), but negative for c-kit (Fig. 3e), discovered on gastrointestinal storomal tumors (Fig. 3f), desmin (Fig. 3g), S100 (Fig. 3h), Melan-A (Fig. 3i), signal tranducer and transactivator 6 (Fig. 3j), insulinoma-associated protein1 (Fig. 3k), CXCL13 (Fig. 3l), ETS transcription factor (Fig. 3m), follicular dendritic cell (Fig. 3n), anaplastic lymphoma kinase (Fig. 3o), human melanoma black, h-caldesmon, and CD1a (Fig. 3p), 10 (Fig. 3q), 21 (Fig. 3r), 23 (Fig. 3s), 31 (Fig. 3t), 34 (Fig. 3u), 68 (Fig. 3v), and 163 (Fig. 3w). Approximately, 1-2% of the tumor cell nuclei expressed the proliferation marker Ki-67 (Fig. 3x).