PMC2822253_01
The EGD shows a submucosal tumor with an irregular central umbilication in the gastric antrum.
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F1
On esophagogastroduodenoscopy (EGD), a submucosal mass with an irregular central umbilication was found in the gastric antrum (Fig. 1).
The abdominal CT reveals a well-demarcated multiseptate cystic mass (arrows) in the gastric antrum.
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F2
Abdominal CT scan revealed a well-demarcated multiseptate cystic mass in the gastric antrum (Fig. 2).
The submucosal mass consists of oligolocular cystic (arrows) and solid areas without overlying mucosal change (H&E stain, x10).
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F3
Microscopically, the cystic portion was lined by a single layer of flat, cuboidal epithelium and surrounded by smooth muscle layers (Fig. 3, arrow and Fig. 4A).
The cystic area (arrows in Fig. 3) shows dilated benign ductal structures lined by cuboidal epithelium (A, H&E stain, x200) and focal periductal glandular structures without islet cell islands (B, H&E stain, x100).
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F4
Periductal glandular structures were focally identified without islet cells (Fig. 4B).
The solid area shows well to moderately differentiated adenocarcinoma with an adjacent dysplastic change in the lining cells of the dilated ductal structures (H&E stain, x40).
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F5
In the solid area, the adenocarcinoma components forming well-formed tubules (Fig. 5) infiltrated the underlying proper muscle layer and the overlying mucosa of the stomach. A dysplastic change was found in the epithelium of the cystic portion of the heterotopic pancreas, adjacent to the invasive adenocarcinoma (Fig. 5).
Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (x40).
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F6
The neoplastic cells and the heterotopic pancreas tissue showed diffusely strong positivity for cytokeratin 7 (CK7+, 1:200, DAKO, Denmark) and negativity for cytokeratin 20 (CK20-, 1:200, DAKO, Denmark) by immunohistochemical stainings (Fig. 6).