PMC5892276_01
Clinical finding before surgery.
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fig1
On palpation, the nodule was elastic firm and mobile (Figure 1).
MRI findings. (a) T1-weighted image. (b) T2-weighted image.
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T1-weighted images; however, it had a high signal area suspecting the subacute bleeding image in the centre of tumor. The lesion showed mostly high signal intensity on T2-weighted images (Figure 2).
Excised tumor: lateral view.
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The overlying mucosa was partly removed, and the wound was closed by sutures (Figure 3).
Clinical finding 6 months after surgery.
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The patient was free of recurrence 2 years after surgery (Figure 4).
(a) Well-defined submucosal mass with cavernous spaces, solid areas, and number of thrombi. (hematoxylin and eosin stain, original magnification x5). (b) Irregular cavernous spaces lined by flat endothelial cells. (hematoxylin and eosin stain, original magnification x100). (c) The spindle-shaped cells in solid areas. (hematoxylin and eosin stain, original magnification x100).
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Microscopically, the lesion was a well-circumscribed mass surrounded by fibrous connective tissue and showed a variety of cellularity imparting a lobular architecture in low power (Figures 5(a)-5(c)).
(a) Cavernous area (vimentin, original magnification x100). Most endothelial cells around blood vessels in cavernous area strongly reacted. (b) Solid area (vimentin, original magnification x200). Spindle cells and epithelioid in solid area are strongly positive.
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Immunohistochemically, most endothelial cells lining the cavernous spaces, spindle cells within solid areas, and epithelioid cells within both areas strongly reacted with vimentin (Figures 6(a) and 6(b)).
(a) Cavernous area (CD34, original magnification x100). Most endothelial cells around vessels in cavernous space are positive. (b) Solid area (CD34, original magnification x200). Spindle cells in solid area are focally positive.
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The endothelial cells lining the cavernous spaces reacted strongly with CD34 (Figure 7(a)), CD 31, factor VIII, smooth muscle actin (SMA) (Figure 8(a)), and Wilms tumor-1 (WT-1) (Figure 9(a)). SMA (Figure 8(b)), and WT-1 (Figure 9(a)), whereas epithelioid cells were positive for SMA (Figure 8(b)), WT-1 (Figure 9(b)) and negative for CD34 (Figure 7(b)), CD31. S100 protein, AE1/AE3, D2-40, and EMA were negative in endothelial cells, epithelioid cells, and spindle cells.
(a) Cavernous area (SMA, original magnification x100). Most endothelial cells around vessels are positive. (b) Solid area (SMA, original magnification x200). Spindle cells in solid area are focally positive.
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fig8
The endothelial cells lining the cavernous spaces reacted strongly with CD34 (Figure 7(a)), CD 31, factor VIII, smooth muscle actin (SMA) (Figure 8(a)), and Wilms tumor-1 (WT-1) (Figure 9(a)). SMA (Figure 8(b)), and WT-1 (Figure 9(a)), whereas epithelioid cells were positive for SMA (Figure 8(b)), WT-1 (Figure 9(b)) and negative for CD34 (Figure 7(b)), CD31. S100 protein, AE1/AE3, D2-40, and EMA were negative in endothelial cells, epithelioid cells, and spindle cells.
(a) Cavernous area (WT-1, original magnification x100). Endothelial cells are strongly positive in cavernous area. (b) Solid area (WT-1, original magnification x200). Spindle cells in solid area are focally positive.
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fig9
The endothelial cells lining the cavernous spaces reacted strongly with CD34 (Figure 7(a)), CD 31, factor VIII, smooth muscle actin (SMA) (Figure 8(a)), and Wilms tumor-1 (WT-1) (Figure 9(a)). SMA (Figure 8(b)), and WT-1 (Figure 9(a)), whereas epithelioid cells were positive for SMA (Figure 8(b)), WT-1 (Figure 9(b)) and negative for CD34 (Figure 7(b)), CD31. S100 protein, AE1/AE3, D2-40, and EMA were negative in endothelial cells, epithelioid cells, and spindle cells.