case_images: PMC11041369_01
case_images: The preoperative examination results and surgical specimen. (A) Abdominal enhanced CT transverse axial view:a nodular object in the antrum was found in the yellow circle; (B) Endoscopic images of the ultrasonic gastroscope; (C) The ultrasound images of mini-probe endoscopic ultrasound: the red arrow indicates a lesion with a heterogeneous internal echo in antrum and the diameter of one section of the lesion was approximately 13.3mm; (D) Surgical specimen:the red arrow points to the tumor.
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case_images: f1
case_images: The 51-year-old female patient who was admitted to our hospital in September 2021,due to "the presence of melena over two weeks." The contrast-enhanced abdominal CT from external hospital showed a nodule in the gastric antrum ( Figure 1A ). In addition, the surrounding mucosal folds were found to be entangled under gastroscopy, and the biopsy forceps were hard to palpation ( Figure 1B ). The ultrasound images of mini-probe endoscopic ultrasound showed that the lesion was hypoechoic, the internal echo was not uniform, and the central part was hyperechoic, which originated from the muscularis propria layer and protrude into the cavity ( Figure 1C ). According to the patient's symptoms and examination results, she was tentative diagnosed clinically with gastrointestinal stromal tumors(GIST), and the "Partial gastrectomy with gastrojejunostomy reconstruction" was performed on September 23, 2021 after excluding severe surgical contraindications.The surgical specimen was revealed to be a solid tumor of 2cmx3cm in size near the greater curvature of the antrum.The tumor grew within the wall of the stomach with a smooth surface and a tough texture ( Figure 1D ).
case_images: Histological findings of the tumor. (A) The tumor shows infiltrative growth in the mucosa, submucosa and muscularis propria; (B) The tumor is composed of epithelium and mesenchyma, which are promiscuously distributed but with clear boundaries; (C) The mesenchyme was composed of dense and sparse regions, and the oedematous changes can be dound in some regions; (D) The tumor cells are arranged in nets and cords in the the epithelioid regions. (Coloration HE, magnificationx100 in A, B, magnificationx200 in C, D).
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case_images: f2
case_images: At low magnification, the tumor showed infiltrative growth in the mucosa, submucosa and muscularis propria ( Figure 2A ). The tumor was composed of epithelium and mesenchyma, which were promiscuously distributed but with clear boundaries ( Figure 2B ). Myxoid degeneration was observed in the stroma, and part of regions showed oedematous changes ( Figure 2C ).In the epithelioid regions, the tumor cells were arranged in nets and cords, and there was a tendency of glandular tube formation and mitotic Figures<5/50HPF ( Figure 2D ).
case_images: Immunohistochemical expression. The tumor cells strongly positive for Ckpan (A),CK7 (B) and Vimentin (C), and Ki-67 proliferation index was less than 5% (D). (Coloration EnVision,magnificationx200).
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case_images: f3
case_images: The tumor cells in the mesenchymal region were strongly positive for Vimentin and CD56 was also expressed in local ( Figures 3A-C ). In both epithelioid and mesenchymal regions, the tumor cells were negative for Desmin, DOG-1, CgA, SMA, Syn, CD-117, CK-20, CD10, CD34 and S-100, SDHB expression normally, and Ki-67 proliferation index was less than 5% ( Figure 3D ).
case_images: The fusion of MALAT1: exon1 and GLI1: exon6 is detected by the whole-transcriptome mRNA sequencing.
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case_images: f4