PMC7302892_01
CT scan showing a heterogenous enhanced gastric mass abutting and probably invading the duodenum and pancreas with multiple metastatic lesions in the liver.
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Computed tomography (CT) scan showed a huge heterogenous contrast-enhanced mass at the stomach body abutting and probably invading the duodenum and pancreas with numerous nodules in bilateral hepatic lobes and peritoneal cavity, including perigastric region (Figure 1).
A giant gastric ulcer over lesser curvature of stomach (right half of the figure) revealed by upper gastrointestinal tract endoscopy.
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An upper gastrointestinal tract endoscopy led to the finding of a giant gastric ulcer over lesser curvature of the stomach (Figure 2).
Poorly differentiated carcinoma of stomach, lesser curvature site, endoscopic biopsy (haematoxylin and eosin stain x400).
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Pathology study of the biopsy specimen from the ulcer confirmed the nature of a poorly differentiated carcinoma (Figure 3) positive for cytokeratin AE1/AE3, with morphology patterns in favour of a gastric rather than a pancreatic origin.
Immunohistochemical staining of DPD. Moderate positivity in tumour cells.
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Immunohistochemical staining afterwards revealed only moderately positive expression of dihydropyrimidine dehydrogenase (DPD) (Rabbit monoclonal DPYD EPR8811: ab134922, Abcam, Cambridge, UK) (Figure 4) and totally negative expression of Bcl-2 (Clone bcl-2/100/D5, NovocastraTM HD, Leica Biosystems, UK) (Figure 5).
Immunohistochemical staining of Bcl-2. Negative in tumour cells; positive for tumour-infiltrating B-cells.
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Immunohistochemical staining afterwards revealed only moderately positive expression of dihydropyrimidine dehydrogenase (DPD) (Rabbit monoclonal DPYD EPR8811: ab134922, Abcam, Cambridge, UK) (Figure 4) and totally negative expression of Bcl-2 (Clone bcl-2/100/D5, NovocastraTM HD, Leica Biosystems, UK) (Figure 5).
CT scan of the abdomen, horizontal view. A. June 8, 2019. Yellow arrow: the huge gastric tumour. B. July 3, 2019. White arrow: gastric perforation site. Green arrow: Necrotising tumour lysis simulating emphysematous pancreatitis.
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An emergent non-contrast CT scan gave a picture of distended stomach fully filled with foods, irregular mottled gas collections between stomach and duodenum, ascites accumulation, and free air in the abdomen cavity, leading to an impression of gastrointestinal tract perforation with the perforation site clearly seen (Figures 6-8).
CT scan of the abdomen, coronal view. A. June 8, 2019. Yellow arrow: the huge gastric tumour. B. July 3, 2019. White arrow: gastric perforation site. Green arrow: Necrotising tumour lysis simulating emphysematous pancreatitis.
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An emergent non-contrast CT scan gave a picture of distended stomach fully filled with foods, irregular mottled gas collections between stomach and duodenum, ascites accumulation, and free air in the abdomen cavity, leading to an impression of gastrointestinal tract perforation with the perforation site clearly seen (Figures 6-8).
CT scan of the abdomen, coronal view. A. June 8, 2019. Yellow arrow: the huge gastric tumour. B. July 3, 2019. Green arrow: Necrotising tumour lysis simulating emphysematous pancreatitis.
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figure8
An emergent non-contrast CT scan gave a picture of distended stomach fully filled with foods, irregular mottled gas collections between stomach and duodenum, ascites accumulation, and free air in the abdomen cavity, leading to an impression of gastrointestinal tract perforation with the perforation site clearly seen (Figures 6-8).