PMC6451149_01
Abdominal enhanced computed tomography. a/b. A smooth-surfaced tumor measuring 70 x 70 mm is noted at the lesser curvature of the middle stomach. The tumor has an internal low-density area and a thick peripheral high intensity area which has an unclear boundary between the stomach. The tumor was suspected to be a submucosal tumor.
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On upper gastric endoscopy, a 70-mm submucosal tumor (SMT) was found at the gastric angle (Fig. 1a and b).
Enhanced abdominal computed tomography at the onset of abdominal pain. a/b. The gastric tumor had moved to the side of the greater curvature and the stomach was twisted. There is no evident contrast failure area of the stomach.
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A computed tomography (CT) showed that her stomach had twisted organoaxially and the SMT had moved to the side of greater curvature (Fig. 2a and b).
Gadolinium-enhanced abdominal MRI. a/b. There is a smooth-surfaced tumor of 70 x 70 mm at the lesser curvature of the middle stomach and almost all parts of the tumor had a high intensity on T2WI. The submucosal tumor had relocated to the original position.
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Abdominal magnetic resonance imaging (MRI) on the following day, which had been already planned to examine the characteristics of the tumor, showed that the tumor had returned to its original position (Fig. 3a and b).
Histopathological examination of the first tumor specimen. a. The cut surface of the white tumor. The tumor had a smooth surface and enclosed a cystic cavity containing a blood clot. b. Hematoxylin and eosin staining of the specimen showed long spindle-shaped cells lined in a bundle with a randomized complex arrangement and growth. c/d. Immunostaining with C-kit, CD34 was positive.
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The tumor size was 90 x 73 mm and the weight was 224.5 g (Fig. 4a). The histopathological findings of the tumor specimen showed long spindle-shaped cells lined in a bundle with randomized complex arrangement and growth, in a storiform pattern (Fig. 4b). The number of mitotic cells was 2 on a 50 high-power field (HPF) (Fig. 4c and d) We diagnosed a GIST with intermediate risk.