PMC8114295_01
Upper gastrointestinal endoscopy revealed an ulcerative lesion on the posterior wall of the stomach.
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Upper gastrointestinal endoscopy showed a huge ulcerative lesion on the posterior wall of the stomach accompanied by a small amount of bleeding (Figure 1).
CT scan images before treatment. (a) Thickening of the posterior wall of the stomach and a continuous heterogeneously enhanced mass protruding outside the stomach wall (white arrow, 23.4 x 21.1 cm). The tumor largely occupied the upper to lower left abdomen. (b) A large tumor in the pelvic cavity was also detected on the CT scan (white arrow, 13.8 x 13.1 cm).
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We performed an abdominal enhanced computed tomography (CT) scan, which revealed thickening of the posterior wall of the stomach and a continuous heterogeneously enhancing mass protruding outside the stomach wall (23.4 x 21.1 cm; Figure 2(a)). Furthermore, another large tumor in the pelvic cavity was also detected on the CT scan (13.8 x 13.1 cm; Figure 2(b)).
CT scan images after imatinib administration. (a) Left upper abdominal tumor size was approximately 17.7 x 11.6 cm (white arrow). (b) Pelvic tumor size was approximately 6.5 x 4.6 cm (white arrow).
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Four months after initiation of imatinib, abdominal enhanced CT revealed that the left upper abdominal mass and the pelvic mass had markedly regressed (17.7 x 11.6 cm and 6.5 x 4.6 cm; Figure 3(a) and (b)), indicating that the imatinib treatment was effective.
Laparoscopic image showing the pelvic tumor originating from the left ovary. The left ovarian tumor presented a swelling that had white regions and was of an irregular and round shape with adherence to the rectum but exhibited no invasion (black arrow). Black arrowhead indicates uterus.
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The left ovary presented a swelling that was white, irregular, and round-shaped with adherence to the rectum but with no invasion (Figure 4).
Pathology of the gastric gastrointestinal stromal tumor (GIST). (a) Histology of the viable region. Spindle cells with oval nuclei arranges in fascicles. Original magnification, x200. (b) Immunohistochemistry - tumor cells positive for CD34 and (c) immunohistochemistry - tumor cells positive for c-Kit.
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Histologically, half of the tumor consisted of hyaline cells with visible spindle cells densely proliferating in the marginal region of the tumor (Figure 5(a)). In immunohistochemistry, the tumor cells were focally positive for CD34 (Figure 5(b)), c-Kit (Figure 5(c)), and DOG1, and negative for SMA and S-100.
Pathology of the ovarian tumor. (a) Histology of the marginal region. Spindle cells proliferating in the fascicle adjacent to the ovarian stroma. Original magnification, x100. (b) Immunohistochemistry for CD34. Same as (a). Spindle tumor cells were positive for CD34, but the ovarian stroma was negative.
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Spindle cells had proliferated in the fascicle adjacent to the ovarian stroma in the marginal region (Figure 6(a)). In immunohistochemistry for CD34, the tumor spindle cells were positive, but the ovarian stroma was negative (Figure 6(b)).