PMC6415473_01
The endoscopic and pathologic findings. On the upper gastrointestinal endoscopy (A), a Borrmann type 3 lesion partially covered by whitish exudate was found in the lesser curvature of the stomach. The biopsy sites in this view are indicated with asterisks. The examination of the biopsy specimen (B) revealed moderately differentiated adenocarcinoma admixed with neoplastic cells, the cytoplasm of which was filled with clear vacuoles of mucin (arrowheads), displacing the cell nucleus to the periphery (hematoxylin and eosin staining). The cytological examination of the peritoneal dialysis effluent (C) revealed clusters of malignant cells (Papanicolaou staining). The scale bar is indicated in each panel.
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Upper gastrointestinal endoscopy performed on hospital day 3 showed an elevated, ulcerated, and friable lesion around the lesser curvature of the stomach, extending from 1 cm below the gastroesophageal junction to near the pylorus with invasion to the anterior and posterior wall of the body, whereas concurrent gastric biopsy specimens revealed moderately differentiated adenocarcinoma (Figure 1A and B). At this point, no cloudy effluent was observed, while a cytological examination of the clear drained dialysate revealed clusters of malignant cells consistent with adenocarcinoma (Figure 1C).
The results of the abdominal CT examination. Select images of the CT scan (A, B) revealed the thickened gastric wall (asterisks) and enlarged lymph nodes (narrow arrow) along the lesser curvature to the antrum of the stomach. A nodular soft tissue lesion in the omentum (arrowhead) and enhanced peritoneal thickening (middle arrows) were also confirmed. The PD catheter within the wall of the abdomen is indicated (wide arrow). CT indicates computed tomography; PD, peritoneal dialysis.
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Small nodular lesions in the omentum and enhanced parietal peritoneum were also demonstrated (Figure 2).