PMC5088541_01
Coronal dynamic computed tomography images showing the sequential changes before and after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). An enlarged lymph node is seen beneath the caudate lobe of the liver before EUS-FNA (a). The lymph node developed a central necrotic area at 10 days after EUS-FNA (b), and was not detectable at 12 months after EUS-FNA (c).
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Computed tomography (CT) showed a lymph node of 47 mm in size that was located above the pancreas head and beneath the liver (Figure 1a, 2a). CT demonstrated a peripherally enhanced low density mass at the location of the enlarged peripancreatic lymph node (Figure 1b, 2b). The lymph node remained undetectable at a follow-up CT examination that was performed at 12 months after EUS-FNA (Figure 1c, 2c).
Horizontal dynamic computed tomography images showing the sequential changes before and after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). An enlarged lymph node is seen beneath the gastric antrum before EUS-FNA (a). The lymph node developed a central necrotic area at 10 days after EUS-FNA (b), and was not detectable at 12 months after EUS-FNA (c). Furthermore, the gastric tumor (white arrows) had become slightly larger in size over the 12-months period (a, c).
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Computed tomography (CT) showed a lymph node of 47 mm in size that was located above the pancreas head and beneath the liver (Figure 1a, 2a). CT demonstrated a peripherally enhanced low density mass at the location of the enlarged peripancreatic lymph node (Figure 1b, 2b). The lymph node remained undetectable at a follow-up CT examination that was performed at 12 months after EUS-FNA (Figure 1c, 2c). The lymph node remained undetectable, but CT showed multiple liver tumors and that gastric tumor had increased (from 50 mm on the first CT to 60 mm) (Fig. 2a and c).
The endoscopy view of the submucosal tumor at the gastric antrum.
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Upper gastrointestinal endoscopy showed a submucosal tumor with ulceration at the gastric antrum (Fig. 3).
Histological sections of the gastric biopsy specimen (x100). A stained section (Hematoxylin and Eosin staining) showing the histological characteristics of neuroendocrine carcinoma, grade 3 (a). The specimens were diffusely positive for chromogranin-A (b), synaptophysin (c), and Ki-67 (d).
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An immunohistological examination of the gastric biopsy specimens revealed a diagnosis of NEC that was positive for chromogranin-A and synaptophysin, with a Ki-67 index of more than 80% (Fig. 4).
EUS-FNA of the enlarged lymph node was performed.
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EUS-FNA of the enlarged lymph node was performed (Fig. 5).
Histological sections of the tissue obtained by EUS-FNA (x100). Stained section (Hematoxylin and Eosin staining) showing the histological characteristics of neuroendocrine carcinoma, grade 3 (a). The specimens were diffusely positive for chromogranin-A (b), synaptophysin (c), and Ki-67 (d).
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The examination of the sample obtained from the lymph node confirmed the immunohistological diagnosis of NEC (Fig. 6).