case_images: PMC11835059_01
case_images: Contrast-enhanced computed tomography. (A-D) The CT revealed a nodule (yellow arrow) with high-density shadow in the gastric body, and ring enhancement in enhanced scan with clear boundaries.
case_images: medi-104-e41308-g001.jpg
case_images: PMC11835059_01_medi-104-e41308-g001.jpg
case_images: F1
case_images: The tumor had a maximum diameter of 6 cm, and the enhanced CT scan showed ring enhancement with well-defined borders (Fig. 1).
case_images: Gastroscopy. The gastroscopy showed multiple gastric polyps as well as a gastric submucosal mass with surface ulceration and mucosal disruption.
case_images: medi-104-e41308-g002.jpg
case_images: PMC11835059_01_medi-104-e41308-g002.jpg
case_images: F2
case_images: After that, the gastroscopy showed multiple gastric polyps as well as a gastric submucosal mass with surface ulceration and mucosal disruption (Fig. 2).
case_images: Hematoxylin-eosin staining. (A) Tumor cells infiltrated the serous layer of the gastric wall (100x). (B) Multiple nuclei cell (red arrow; 200x). (C) Spindle cells around the blood vessels showing a typical 'onion-skin' appearance (red arrow; 200x). (D) Greater infiltration of lymphocytes, plasma cells, and mast cells was noted in the stroma (400x). (E) Eosinophil infiltration was seen in the focal area (400x). (F) The dilated cystic wall is lined with a single columnar epithelium without cell atypia, and the cavity is filled with eosinophilic secretion and debris (40x). (G) Some of the glands were inverted into the submucosa, muscularis propria (40x). (H) Some of the glands were invaginated into the submucosa, muscularis propria (40x). (I) The tumor was diffusely strong expression of CD34 (200x). (J) The tumor was diffusely strong expression of PDGFRA (200x). (K) The tumor was negative of CD1a (200x). (L) The tumor was negative of Langerin (200x).
case_images: medi-104-e41308-g003.jpg
case_images: PMC11835059_01_medi-104-e41308-g003.jpg
case_images: F3
case_images: Hematoxylin-eosin staining revealed that the tumor realm was unclear and that the tumor center was mainly located in the mucosa and submucosa, infiltrating the muscularis propria and serosa of the gastric wall (Fig. 3A). The tumor mainly comprised moderate amounts of spindle and oval cells and relatively fewer heterotype or strange cells with large or multiple nuclei (Fig. 3B). In focal region, spindle cells around the blood vessels showed the typical 'onion-skin' appearance (Fig. 3C). Greater infiltration of lymphocytes, plasma cells, and mast cells was noted in the stroma (Fig. 3D). In particular, increased eosinophil infiltration was seen in the focal area (Fig. 3E), and focal myxoid stroma was observed. The surface of the mass was covered with gastric mucosa, and some of the glands were cystically dilated (Fig. 3E, F) and inverted into the submucosa, muscularis propria, and tumor stroma (Fig. 3G, H). The dilated cystic wall was lined with a single columnar epithelium without cell atypia, and the cavity was found to contain eosinophilic secretion and debris (Fig. 3E). On immunohistochemistry, the tumor cells showed diffusely strong expression of CD34 (Fig. 3I) and PDGFRA (Fig. 3J); they were sporadically positive for S-100 protein and negative for CD117, DOG-1, smooth muscle actin, Caldesmon, ALK-80, ER, CD21, Bcl-2, STAT6, CD68, CD163, CD1a (Fig. 3K), and CD207 (langerin; Fig. 3L).