PMC1781460_01
1a and b- CT scan of the abdomen and pelvis with oral and intravenous contrast demonstrating a large, multicentric GIST with extensive collateral circulation extending from the upper abdomen to the pelvis. 1c and d- Intraoperative photos of the mass being delivered from the abdomen.
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F1
An abdominal computed tomography demonstrated a large, multicentric tumor with extensive collateral circulation (Fig 1a and 1b). The following day, extensive tumor debulking of both the dominant mass and 99% of the remaining multifocal 40 cm x 25 cm x 10 cm GIST was achieved (Fig 1c and 1d), obtaining an R1 resection.
Electrophergram of the mid portion of exon 9 of KIT from this patient's GIST showing two alleles, one with a 6 bp tandem repeat insertion (GCCTAT) leading to a duplication of amino acids alanine and tyrosine at codons 502 and 503 (enclosed in the square).
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F2
This led to a duplication of amino acid residues alanine 502 and tyrosine 503 (Fig 2).
3a- In situ hybridization: IGF-II mRNA sense probe (200x). 3b- In situ hybridization: IGF-II mRNAantisense probe (200x). 3c- Immunohistochemistry: Polyclonal rabbit anti E [68-88] domain of human pro-IGF-II ("big" IGF-II) (dilution 1:50) (200x). 3d- Immunohistochemistry: Polyclonal rabbit anti-human IGF-II (dilution 1:100) (200x).
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F3
IGF binding protein 6 (IGFBP-6) were reported to be within the normal range. In situ hybridization of the tumor samples demonstrated high expression of IGF II mRNA and elevated pro-IGF II (figure 3).