case_images: PMC10715813_01
case_images: Gastroscopic, radiological, histopathological and immunohistochemical features of case 1 Gastroscopy (A, arrow) and abdominal CT scans (B, arrow) showed a thickened lesion in duodenal papilla. The abdominal CT scan showed multiple liver metastases (C, triangles), intraperitoneal metastases and retroperitoneal lymph node metastases (C, arrows) after chemotherapy. The biopsy showed a solid pattern with poorly differentiated tumor cells with inflammatory infiltration (D, magnification x40; and E, magnification x400). BRG1 was deficient. PCK, CgA, Syn and CD56 were positively stained. The Ki67 index was approximately 90% (magnification x400).
case_images: fonc-13-1290717-g001.jpg
case_images: PMC10715813_01_fonc-13-1290717-g001.jpg
case_images: f1
case_images: Gastroscopy showed a 1.5-cm thickened lesion in the duodenal papillae ( Figure 1A ), and a biopsy was performed. A computed tomography (CT) scan of the abdomen showed a 1.5-cm thickened lesion in the duodenal papillae ( Figure 1B ) and multiple nodules in the liver, indicating metastases of the liver. Morphological analysis of the biopsy tissue showed poorly differentiated cells forming a solid architecture of neuroendocrine morphology ( Figures 1D, E ). Immunohistochemistry ( Figure 1 ) indicated complete loss of BRG1 in the tumor nuclei, with endothelial and inflammatory cells as internal positive controls. The CT scan of the abdomen and gastroscopy showed a 3.0-cm thickened lesion in the duodenal papillae, multiple liver metastases ( Figure 1C , triangles), and intraperitoneal metastases, and enlarged and partially fused retroperitoneal lymph nodes ( Figure 1C , arrows).
case_images: PMC10715813_02
case_images: Gastroscopic, radiological, histopathological and immunohistochemical features of case 2 Gastroscopy (A, arrow) and abdominal CT scans (B, arrow) showed an irregularly thickened area in the greater curvature of the stomach before neoadjuvant treatment. The biopsy showed a solid pattern with poorly differentiated tumor cells before neoadjuvant treatment (C, magnification x100). Gastroscopy (D, arrow) and abdominal CT scans (E, arrow) showed a larger irregular thickened area of the greater curvature of the stomach after neoadjuvant treatment. The resected tumor showed a solid pattern with poorly differentiated tumor cells after neoadjuvant treatment, and there was no obvious response to neoadjuvant therapy (TRG3) (F and G, magnification x400). Both biopsy tissue and surgical resected tumor showed similar immunohistochemical staining. BRG1 was deficient. PCK staining was positive. CgA, Syn and CD56 were positively stained. P53 staining was positive, and RB staining was deficient. The Ki67 index was approximately 70% (magnification x400).
case_images: fonc-13-1290717-g002.jpg
case_images: PMC10715813_02_fonc-13-1290717-g002.jpg
case_images: f2
case_images: Gastroscopy ( Figure 2A ) and a CT scan of the abdomen ( Figure 2B ) showed a 2.9-cm irregular ulcerative tumor in the greater curvature of the stomach, and a biopsy was performed. Gastroscopy ( Figure 2D ) and a CT scan of the abdomen ( Figure 2E ) showed a larger irregular ulcerative tumor in the greater curvature of the stomach after neoadjuvant chemotherapy. The biopsy tissue and resected tumor showed poorly differentiated morphology with solid architecture ( Figures 2C, F, G ). TRG3 (without an obvious response to neoadjuvant treatment) ( Figure 2F ). The immunohistochemical staining results of the resected tumor were similar to those of the biopsy. Complete loss of BRG1 was observed in the tumor nuclei, which was similar to the result for case 1 ( Figure 2 ).