PMC3870639_01
Upper GI endoscopy, showing a giant submucosal-like tumor in the stomach with oozing from an ulceration.
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Upper GI endoscopy revealed a giant lesion within the stomach, located at the posterior wall of the body, showing a submucosal tumor-like appearance with oozing from ulceration (Figure 1).
(a) Abdominal computed tomography (CT) scan showing a giant mass with central necrosis in the stomach. (b) Abdominal computed tomography scan showed a peritoneally disseminated lesion, measuring 30 x 30 mm in size (arrow).
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A plain CT scan showed a mass with central necrosis in the stomach, with suspected infiltration of the spleen and tail of the pancreas (Figure 2(a)), as well as peritoneal dissemination (Figure 2(b)).
Resected specimen of the giant submucosal tumor-like mass in the stomach. The pathological specimen included the stomach, spleen, part of the pancreas tail, and disseminated lesions. The cut surface of specimen showed necrosis and hemorrhage. On gross examination, the body of the stomach revealed a protruding tumor covered with mucosa and measuring 20 x 18 x 11 cm in size.
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Gross examination showed an exophytically-growing tumor in the stomach, measuring 20 x 18 cm (Figure 3) and weighing approximately 3000 g.
(a) Histologic assessment of the tumor showing the presence of an epithelial component and a nonepithelial sarcomatoid component. The epithelial component showed glandular differentiation, while the sarcomatoid component revealed a complicated growth of spindle-like and oval cells with a pleomorphic and bizarre configuration of the nuclei showing mitosis (HE). (b) Immunohistochemical assays showing that the sarcomatoid component was moderately reactive to antibody against pancytokeratin. (c) The sarcomatoid component was strongly reactive to antibody against vimentin.
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Both components infiltrated the peripancreatic fat and the sub-mucosal to sub-serosal areas of the stomach wall (Figure 4(a)). The epithelial component was strongly positive for pancytokeratin, CEA and CA19-9; moderately positive for desmin, and negative for vimentin (Figure 4(b)).