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case_images: Plain computed tomography (a) showing calcification at the margins and inside of the mass. No clear contrast enhancement effect was observed on contrast-enhanced computed tomography (b).
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case_images: Radiological findings indicated the possibility of gastrointestinal stromal tumor extending outside the gastric wall (Figure 1).
case_images: White light imaging (a): After pyloric gastrectomy and Billroth 1 method reconstruction. There was no obvious mass in the gastric lumen; Endoscopic ultrasound (b): Post-acoustic shadow with low-echoic mass. Post-acoustic shadow (yellow arrow); Tumors appear to be in continuity with the gastric wall (white arrow); Contrast-enhanced endoscopic ultrasound (c): No influx of perflubutane into the mass.
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case_images: Contrast imaging with perflubutane revealed only a faint contrast in the marginal parenchyma, with no obvious bubble inflow into the interior (Figure 2). Considering the submucosal mass with heterogeneous internal characteristics originating from the muscularis propria, a highly malignant gastrointestinal stromal tumor was considered a differential diagnosis.
case_images: A string of gauze with necrotic tissue was obtained using a 19-gauge needle. Hematoxylin and eosin stain, x100 (a); Polarized illumination. Polarized light microscopy was used to highlight the cotton fiber (b).
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case_images: Histopathological findings revealed predominantly necrotic tissue, comprising a fibrous interstitium with hyalinization; cotton fibers were confirmed using polarized illumination, leading to a diagnosis of gossypiboma (Figure 3).
case_images: Computed tomography at 1 month after endoscopic ultrasound fine-needle aspiration. Computed tomography scan after endoscopic ultrasound fine-needle aspiration reveals the presence of gas within the mass (white arrow). (a) Resected specimen; (b) Hematoxylin and eosin stained specimen (x100). The postoperative specimen reveals a fragmented filamentous foreign body within the granulation tissue with hyalinization and ossification; (c) Polarized illumination. Polarized light microscopy was used to highlight the cotton fiber (d).
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case_images: Splenectomy and tumor removal surgery were performed 3 months after FNA, and cotton fibers were found in the granulation tissue, similar to the FNA specimen (Figure 4).