PMC4929380_01
GIST presenting as a SMT of the stomach. a Upper gastrointestinal endoscopy shows a SMT of the stomach, 38 mm in diameter. b Contrast-enhanced computed tomography shows a slightly low-density area on the internal surface of the gastric wall compared to that of the adjacent wall.
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F1
Endoscopy showed an elevated gastric mucosa (fig. 1a). Contrast-enhanced computed tomography (SOMATOM Emotion 16; SIEMENS, Munich, Germany) was performed for further analysis of the submucosal tumor (fig. 1b).
a EUS shows a low-echo lesion, 3.5 cm in diameter. Color Doppler image shows a vascular signal extending into the center (arrow). b 22G EUS-FNA was performed (arrowhead).
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F2
A hypoechoic lesion with a clear margin was seen (fig. 2a). EUS-FNA was performed for pathological evaluation of the submucosal tumor with a 25G biopsy needle (ECHO-HD-25c, Cook Medical Inc., Bloomington, Ind., USA) (fig. 2B).
Histological analysis of EUS-FNA cytology specimens. Hematoxylin and eosin staining (a), S100 (b), alpha-smooth muscle actin (c), Ki-67 (d), CD34 (e), CD117 (f). Original magnification: x200. Scale bars = 100 mum.
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F3
A fragment of tissue was obtained from the clot and was stained using hematoxylin and eosin (fig. 3a). No signal was observed on immunostaining with antit-S100, a marker of nerve cells (fig. 3B) or anti-alpha smooth muscle actin, a marker of smooth muscle cells (fig. 3c). Approximately 3% of the cells were positive for Ki-67 (fig. 3d). The cells were strongly positive for anti-CD34 (fig. 3e) and anti-CD117 (fig. 3f).