case_images: PMC11056590_01
case_images: PMC11056590_02
case_images: PMC11056590_03
case_images: Endoscopic images, Ulcer at the fundus junction of the gastric body (A); ulcers at the small bend of the sinus junction (B, C): ulcers at the descending duodenal bulb (C).
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case_images: On the first gastroscopy the patient had two 1.0 cm ulcers at the fundus junction of the gastric body ( Figure 1A ), 2.0 cm ulcers at the small bend of the sinus junction ( Figure 1B ), yellow moss, surrounding mucosal congestion and oedema, 1.5 cm ulcers at the descending duodenal bulb ( Figure 1C ) with yellow moss and diverticulum.
case_images: PMC11056590_04
case_images: Irregular hypoechoic area in the splenic hilar region (A) encompassing the splenic vein (B) with several blood flow signals noted in this area and a very hypoechoic area in the left middle abdomen to the splenic hilar region, which is poorly demarcated from the gastric wall, gastric sinus, and spleen (C), and rich blood flow signals in the area (D) with thickening of the greater omentum and enhanced echogenicity and several blood flow signals on the omentum, (E), and several lymph nodes in the abdominal cavity and adjacent to the abdominal aorta (F).
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case_images: The patient underwent abdominal ultrasonography, which revealed the following: an irregular hypoechoic area in the splenic hilar region that resembled "coral" and was continuous with a patchy hypoechoic area in the lower part of the spleen; the splenic vein is wrapped around this hypoechoic zone, with no widening; a patchy, very hypoechoic area was noted in the left middle abdomen to the splenic hilar region, spanning 230 x 80 mm and poorly demarcated from the gastric wall, gastric sinus, and spleen with a rich blood flow signal; a thickened (36 mm), echogenic greater omentum; color Doppler flow imaging (CDFI)show a little blood flow signal noted in the omentum; several lymph nodes visualized in the abdominal cavity and adjacent to the abdominal aorta, the larger of which was 25 mmx18 mm; and CDFI, a little blood flow signal was detected in the lymph nodes ( Figures 2A-F ).
case_images: SonoVue contrast-enhanced ultrasound. (A) Hyper-enhancement of the mass in the early arterial phase at 13 seconds; (B) localized washout at 18 seconds; (C) hypo-enhancement area of the mass increased at 1 min and 40 seconds; (D) significant washout showed approximately no enhancement at 2 min and 54 seconds; (E) iso-enhancement of the abdominal lymph nodes at 1 min and 7 seconds; (F) hypo-enhancement of the left mid-abdominal mass at 1 min and 52 seconds.
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case_images: A patchy, very hypoechoic area was noted in the left mid-abdomen to the splenic hilar region, as well as multiple enlarged lymph nodes in the abdominal cavity and retroperitoneum when combined with contrast-enhanced ultrasound (CEUS), suggesting neoplastic lesions (poorly demarcated from the gastric wall and spleen) and lymphomas ( Figures 3A-F ).
case_images: PMC11056590_05
case_images: CT apparent irregular thickening of the gastric fundus and sinus wall with enlargement of multiple lymph nodes (A-D), suggesting a neoplastic lesion, such as gastric cancer with lymph node metastases, and localized peritoneal thickening in the form of nodules and masses, suggesting peritoneal metastases (E, F).
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case_images: A large volume of ascites and peritonitis was noted ( Figure 4A-F ).
case_images: PET-CT showed high uptake of 18F-FDG in multiple abdominal organs (A), with the larger uptake located in the splenogastric space and poorly demarcated from the spleen and stomach (B-D).
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case_images: A PET-CT (the co-expression agent was 18F-FDG) showed the following: 1. enlargement of multiple lymph nodes in the mediastinum, left medial breast, and cardiophrenic angle area, with increased FDG metabolism; 2. multiple nodules and masses in the abdominal cavity, and larger nodules and masses are located in the splenic-gastric hiatus and are poorly delineated from the spleen and stomach with increased FDG metabolism; 3. thickening of the hepatic and splenic peri-membranes with increased FDG metabolism; and 4. diffuse thickening of the peritoneum and mesentery with FDG metabolism, suggesting a malignant neoplastic lesion, such as a lymphoma or sarcoma ( Figure 5 ).
case_images: PMC11056590_06
case_images: HE staining of the pathological section reveals diffuse enlargement of large B-cell lymphocytes (A, B).
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case_images: The pathological section revealed diffuse enlargement of lymphocytes, nuclear divisions are more visible( Figures 6A, B ).
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