case_images: PMC10014732_01
case_images: (A) ESDGastroscopy of case 1 showed a circumferential uplift lesion on the greater curvature of the antrum, with central depression, the maximum diameter of 5.0cm, and uneven surrounding mucosa. (B) ESD surgical resection specimen of Case 1. (C) Gastroscopy of Case 3 showed a submucosal bulge below the gastric cardia, with a maximum diameter of 2.0cm, and a shallow ulcer on the surface. (D) ESD resection specimen of Case 3. (E) In case 3, a gastric cancer radical specimen after ESD showed a mucosal defect in the cardia (caused by).
case_images: fonc-13-1059815-g001.jpg
case_images: PMC10014732_01_fonc-13-1059815-g001.jpg
case_images: f1
case_images: The disease manifested endoscopically as SMTs ( Figures 1A. Three patients underwent local mass resection ( Figures 1C, D ), followed by radical gastrectomy for GC ( Figure 1E ), one underwent endoscopic submucosal dissection (ESD).
case_images: (A) Under low power microscope, case 1 showed that the tumor was located in the submucosa and the surface epithelium was intact. The tumor was nodular distribution, rich in mucus with floating cancer cells. (B) In case 1, the tumor cells showed dichromatic cytoplasm, large nuclei, prominent nucleoli, arranged in irregular nests, and located in the mucus pool. (C) In case 3, the tumor was located in the submucosa, rich in mucus, and locally continuous with the surface epithelium. (D) In case 3, the tumor cells were columnar, with abundant cytoplasm and mucus, and small nuclei located at the base. The tumor cells were arranged in glandular and papillary patterns. (E) In case 4, the tumor was located in the submucosa with nodular distribution, and the stroma was rich in lymphocytes with lymphoid follicles. (F) In case 4, the tumor cells were syncytial, with chromophilic cytoplasm, large nuclei, prominent nucleoli, and arranged in irregular nests. The immunohistochemical results of case 4 showed that the tumor cells expressed CKpan (G) and EBER (H).
case_images: fonc-13-1059815-g002.jpg
case_images: PMC10014732_01_fonc-13-1059815-g002.jpg
case_images: f2
case_images: Under the microscope, the SMT specimen of the patient with a poorly differentiated mucinous adenocarcinoma exhibited a nodular distribution with copious extracellular mucin ( Figure 2A ). Tumour cells were epithelium-like, possessed a large nucleus and distinct nucleoli, and floated within mucin pools in small nest-like clusters ( Figure 2B ). This was locally accompanied by the formation of mucin pools ( Figures 2C, D ). Histological examination of the SMT specimens of case 4 showed the presence of a nodular structure and a lymphocyte-rich mesenchyme, accompanied by lymphoid follicle formation ( Figure 2E ). At high magnification, the tumour cells exhibited a symplastic appearance with a dichroic cytoplasm, a large nucleus, distinct nucleoli, and an irregular nest- and sheet-like arrangement ( Figure 2F ). The tumour cells of the four cases showed differing expression levels of the gastric mucins MUC1 (4/4), MUC5AC (2/4), MUC6 (2/4), CEA (4/4), CKpan (4/4)( Figure 2G ) and CK7 (3/4). The intestinal markers MUC2, CDX2 and CK20 were expressed in case 1, and EBER was expressed in the tumour cells of case 4 ( Figure 2H ).