PMC5507799_01
Initial contrast-enhanced computed tomography images. Thickening of the entire circumference of the gastric body wall (arrows) was displayed. A swollen lymph node was displayed in the lesser curvature (arrowhead).
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Contrast-enhanced computed tomography (CECT) displayed thickening of the entire circumference of the gastric body wall and an enlarged lymph node at the lesser curvature (Figure 1).
Digital subtraction angiography (DSA) images of the celiac artery and left gastric artery. (A) Selective celiac artery angiography. The left hepatic artery (black arrow) and left subphrenic artery (white arrow) branched from the left gastric artery. (B) Selective left gastric artery angiography. (C) The pseudoaneurysm was located on a branch from the left gastric artery (arrowhead). (D) After the embolization using gelatin sponge and EmboSpheres the target branch was occluded completely.
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Digital subtraction angiography (DSA) displayed the left subphrenic and left hepatic arteries branching from the left gastric artery (Figure 2A). A pseudoaneurysm was observed in a branch of the left gastric artery (Figure 2B, 2C). The inner microcatheter was advanced to this branch of the left gastric artery and gelatin sponge particles were infused until the proximal side of the branch was completely embolized (Figure 2D).
DSA images of the right gastroepiploic artery. (A) Although extravasation and pseudoaneurysm were not displayed, the tumor staining was seen along the gastric wall in the greater curvature. (B) After embolization using EmboSpheres only, final angiography showed disappearance of tumor staining and the remaining main trunk of the right gastroepiploic artery (arrow).
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Similarly, we performed DSA from the right gastroepiploic artery, which displayed tumor blush in the greater curvature (Figure 3A). After the embolization, the main trunk of the right gastroepiploic artery remained visible on DSA (Figure 3B).
Contrast-enhanced computed tomography images. (A) Two days after embolization neither the gastric body wall nor the swollen lymph node in the lesser curvature were enhanced (arrowheads). On the other hand, the gastric body wall in the greater curvature remained enhanced (arrows). An area of the gastric wall mucosa membrane in the lesser curvature was collapsed (yellow arrows). (B) A low-density area was located in segment 4 of the liver, indicating infarction (circle).
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Two days after the TAE, CECT showed no re-bleeding and extravasation, and the gastric wall of the greater curvature had preserved perfusion (Figure 4A). Necrosis was observed specifically in segment 4 of the liver (Figure 4B).
Gastric cancer specimen. (A) The area of the ulcer that adhered to and remained on the patient's pancreas (asterisk), areas of hemorrhage (surrounded by solid lines) and a thick gastric wall (region surrounded by the dotted line) were macroscopically observed. (B) Cross-section after sectioning showed thick and white regions, which indicated cancer cell infiltration. (C) The spread of cancer cells is indicated with white lines. (D) The number of EmboSpheres detected in each region of the specimen.
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Macroscopic and microscopic pathological findings of the specimen are shown in Figures 5-7. The actual number of EmboSpheres was counted in all of the gastric specimen slides (Figure 5D) A large number of EmboSpheres was observed in areas that were fed from the left gastric artery and right gastroepiploic artery.
Pathological findings on hematoxylin and eosin staining. (A) The lesion due to the ulcer near the mucosa formed a slope. (B) High-power field of the area within the square in (A). Hemorrhage, venous stasis and necrotic cancer cells were observed in the submucosal layer. (C) The posterior wall in the greater curvature - numerous and dense cancer cells were observed in the submucosa and between the muscles. (D) The anterior wall in the greater curvature - few cancer cells were observed compared with the posterior wall.
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Macroscopic and microscopic pathological findings of the specimen are shown in Figures 5-7.
Pathological images showing embolic agents embolizing all arteries in the submucosa of the gastric wall. (A) An EmboSpehre. (B) 6 EmboSpheres. (C) 19 EmboSpheres. (D) 42 EmboSpheres. (E) EmboSpheres (arrows) and gelatin sponge (arrow head) embolizing one artery. (F) EmboSpheres (arrow), embolization and hemorrhage (asterisk).
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Macroscopic and microscopic pathological findings of the specimen are shown in Figures 5-7.