PMC9653302_01
MRI spine showing multiple lytic lesions demonstrating post-contrast enhancement (widespread variable-sized bony metastatic versus myeloma lesions in the cervical, thoracic, lumbar, and sacral spine). Lesions exemplified with solid white arrows.
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Computed tomography (CT) of the abdomen with oral and intravenous administration of contrast, conducted initially to rule out intestinal obstruction, incidentally showed suspicious thickening in the gastric pylorus and multiple osseous lytic lesions, which were later confirmed by magnetic resonance imaging (Figure 1).
Positron emission tomography (PET scan) of the patient revealing multiple areas of uptake. (a) The solid white arrows show vertebral osteolytic lesions at multiple levels throughout the spine. (b) The solid white arrow denotes the uptake in left-sided pleural-based lesion, and the hollow white arrow shows the uptake in segment IV of the liver. (c) The solid white arrow demonstrates the uptake in the lateral aortic lymph node, and the hollow white arrow shows hypermetabolic spleen. (d) The solid white arrow shows the uptake in the pylorus of the stomach, and the hollow white arrow demonstrates the uptake in aortocaval lymph node. (e) The hollow white arrows denote lytic lesions in the bony pelvis.
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Positron emission tomography-CT showed increased uptake in multiple osseous lytic lesions, liver, retroperitoneal lymph nodes, and pleural lesions (Figure 2).
Endoscopy (solid white arrow) showing gastric mass (an irregular, infiltrative lesion causing partial obstruction of pyloric channel suggestive of adenocarcinoma or lymphoma)
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Esophagogastroduodenoscopy, which was performed because of thickening in gastric pylorus on CT, showed an antral infiltrative lesion with partial pyloric channel obstruction, which suggested gastric adenocarcinoma or lymphoma (Figure 3).
(A) Tumor cells aggregating in small clusters and single cells (black arrows) in pools of mucin (stars). Hematoxylin and eosin (H&E) staining, 200 x . (B) Tumor cells (black arrows) infiltrating gastric submucosa. Adjacent non-neoplastic mucosal glandular lining is also noted (stars). H&E staining, 200 x . (C) Tumor cells expressing PD-L1 immunostain (black arrows). PD-L1 immunohistochemical stain, 200 x . (D) Negative Her2/neu immunostain (black arrows point at tumor cells). Her2/neu immunohistochemical stain, 200 x .
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Pylori) (Figure 4).