PMC4025115_01
Upper endoscopic examination revealed a localized, fixed and firm subepithelial tumor (diameter, 2.2 cm) in the peripyloric area.
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F1
Upper endoscopic examination revealed a localized, fixed and firm subepithelial tumor (diameter, 2.2 cm) in the peripyloric area, but there was no evidence of gastric ulcer in the entire stomach (fig. 1).
a A Stomach CT scan before the treatment revealed two non-enhancing, low-attenuated liver masses in S4 (2.2 cm) and S5 (1.6 cm) suggesting metastasis. b Abdominal CT scan 3 months after sandostatin LAR therapy. There was progression of hepatic metastasis without tumor recurrence in the operated bed. c Follow-up abdominal CT after 6 cycles of EP chemotherapy. There was no significant interval change in the size and number of hepatic metastasis.
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F2
S4 (2.2 cm) and S5 (1.6 cm) suggesting metastasis (fig. 2a). Sequentially performed liver MRI showed several additional metastatic nodules. However, abdominal CT, which was performed 3 months later, revealed progression of the hepatic metastases without tumor recurrence in the operated bed (fig. 2b). Despite 3 cycles of EP chemotherapy, response evaluation identified a stable disease status, and eventually, her disease progressed after 6 cycles of EP chemotherapy (fig. 2c).
a Histology. The tumor was composed of medium-sized, round or polygonal cells with eosinophilic cytoplasm and round nuclei with a fine chromatin pattern also known as 'salt-and-pepper nuclei'. HE. x400. b, c Immunohistochemistry. The tumor cells exhibited positive staining for chromogranin A and CD56. d The Ki-67 labeling index was 4%.
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F3
Microscopically, the tumor cells were medium-sized and uniform in shape and showed moderate cellularity with mild mitosis (<1/50 per high-power field) (fig. 3a). On immunohistochemical staining, the tumor cells were positive for chromogranin A and CD56a (fig. 3b, c). The Ki-67 labeling index was 4% (fig. 3d), and the serum gastrin level was increased to 1,832 pg/ml (normal range 0-108).
The stomach CT (b) performed after 3 months of octreotide plus IFN-alpha showed an interval decrement of metastatic liver masses compared to the previous CT scan (a).
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F4
On response evaluation after 3 months of treatment, she showed favorable response with regression of liver metastasis (fig. 4).