PMC9650230_01
The imaging results of contrast-enhanced CT scans of the abdomen and pelvis: (A, C) The arrows point to a soft tissue mass approximately 33 mmx54 mm in the posterior wall of the gastric body. (B, D) The arrows point to a protrusion into the right wall of bladder, approximately 26 mmx29 mm in size of round lumps.
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And there were no obvious abnormal signs in the rest of the body ( Figures 1A-D ).
Pictures of GIST and PGL during and after surgery: (A) Intraoperative finding of a stromal tumor in the posterior wall of the gastric corpus which the arrows point to. (B) An enlarged nodule adjacent to the GIST pointed by arrows, which was initially suspected to be a lymph node metastasis from the stromal tumor but was diagnosed as hyperplastic fibrous connective tissue by cytopathology. (C) After incision of the peritoneum and the anterior wall of the bladder, a mass pointed by arrows on the right side of the bladder protruding into the bladder was found, which was confirmed by pathology as a PGL. (D, E) GIST after resection and its transverse section, approximately 6 cm in length. The tumor capsule was intact and limited, the section was brown, located in the inherent muscle layer.
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After the MDT discussion, the patient underwent laparoscopic surgery on October 9 in 2021, During the operation, a mass of approximately 55 mm x 35 mm in the posterior wall of the gastric body was found, and wedge resection of stomach was performed ( Figures 2A, D, E ). At the same time, several nodules suspected of enlarged lymph nodes on the greater omentum adjacent to the mass were excised together ( Figure 2B ) and sent for frozen-section. According to the above situation, an ectopic PHEO was suspected, the urologist was invited for intraoperative consultation, and confirmed that the mass came from the right side of the bladder apex ( Figure 2C ).
Histopathological and immunohistochemical results of GIST: (A) Spindle-shaped tumor cells on HE staining. (B) Epithelioid tumor cells on HE staining. (C) Tumor cells with diffuse CD117 positivity. (D) Tumor cells were diffusely positive for DOG1. (E) Tumor cells were diffusely SDH negative under the SDH positive control of vascular endothelial cells.
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The immunohistochemical (IHC) result showed tumor cells were CD117(+), DOG-1(+), SDHB(-), and Ki-67 5% ( Figure 3 ).
Histopathological and immunohistochemical results of PGL: (A) The cells of the bladder tumor were arranged in nests under HE staining, with abundant cytoplasm and stroma rich in thin-walled blood vessels. (B) Tumor cells showed diffuse CgA positivity. (C) Tumor cells showed diffuse Syn positivity. (D) Tumor cells showed diffuse SDH negativity; vascular endothelial cells served as an SDH positive control.
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Under HE staining, it was composed of tumor cells of uniform size with abundant cytoplasm arranged in nests, with IHC CgA (+), Syn (+), SDHB(-), and Ki-67 2% ( Figure 4 ).