case_images: PMC3934807_01
case_images: a Gross appearance of the surgical specimen. The type 2 tumor was located near the pylorus. b Hematoxylin-eosin staining confirmed the presence of adenocarcinoma with a tubulopapillary growth pattern (x70). c PAS stain showed that the clear cytoplasm was almost filled with fine granular glycogen (x280).
case_images: crg-0008-0001-g01.jpg
case_images: PMC3934807_01_crg-0008-0001-g01.jpg
case_images: F1
case_images: Macroscopically, the type 2 tumor was located near the pylorus and measured 20 x 15 mm (fig. 1a). Histological examination demonstrated the presence of adenocarcinoma with a tubulopapillary growth pattern (fig. 1b). Periodic acid-Schiff (PAS) stain showed that the clear cytoplasm was almost filled with fine granular glycogen (fig. 1c).
case_images: a Tumor cells were positive for AFP, which was mainly expressed in the cytoplasm of tumor cells (x70). b Tumor cells were positive for CEA, which was mainly expressed in the apical surfaces of tumor cells (x70). c CDX2 was expressed strongly in the tumor cell nuclei (x70). d CD10 was positive in the luminal surfaces in some tumor cells (x140).
case_images: crg-0008-0001-g02.jpg
case_images: PMC3934807_01_crg-0008-0001-g02.jpg
case_images: F2
case_images: AFP (fig. 2a), carcinoembryonic antigen (CEA) (fig. 2b), caudal-type homeobox transcription factor 2 (CDX2) (fig. 2c) and common acute lymphoblastic leukemia antigen (CD10) (fig. 2d). AFP was mainly expressed in the cytoplasm whereas
case_images: a FDG-PET confirmed No. 8p lymph node recurrence. b CT revealed gastrointestinal obstruction near the anastomotic site of gastroduodenostomy due to No. 8p lymph node recurrence.
case_images: crg-0008-0001-g03.jpg
case_images: PMC3934807_01_crg-0008-0001-g03.jpg
case_images: F3
case_images: However, 15 months after the initial surgery, serum levels of AFP increased to 279.4 ng/ml, and fluorodeoxyglucose positron emission tomography (FDG-PET) revealed No. 8p lymph node recurrence (fig. 3a). A CT scan revealed gastrointestinal obstruction near the anastomotic site of gastroduodenostomy due to No. 8p lymph node recurrence (fig. 3b).