PMC3959485_01
(A) Upper GI endoscopy showing a nodular lesion with smooth surface in the gastric fundus. A central ulcer is also seen. (B) A sessile polyp is seen in the first part of duodenum on endoscopy. (C) Low grade GIST with fascicles of spindle cells. (H&Ex10). Normal gastric mucosa (N) is seen. (D) CD117 positivity in the gastric GIST. Normal glands(N) are seen on the surface. (IHCx10). (E) Histology of duodenal polyp showing nests of neuroendocrine tumor on the left. Normal glands (N) are seen on the right. (H&Ex20). (F) Neuroendocrine tumor of duodenum showing strong positivity for Synaptophysin. Normal mucosa is negative (IHCx20)
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F1
Microscopically, the tumor was seen in the submucosa and wall and was composed of fascicles of spindle cells (Fig. 1C). Immmunohistochemistry demonstrated positive staining for CD117 (Fig. 1D) and CD34. It was composed of nests and cords of round to oval tumor cells, separated by thin fibrous septae and was seen infiltrating the muscle (Fig. 1E). Immmunohistochemistry showed strong staining for Synaptophysin confirming the neuroendocrine nature (Fig. 1F).
PMC3959485_02
(A) Wedge resection of stomach showing a firm submucosal nodule in the wall (bold arrow).Normal gastric mucosa is seen (thin arrow). (B) Spindle cell tumor in the submucosa and wall. Mucosa (N) appears normal. (C) Large constricting growth in the sigmoid colon. (Bold arrow). Multiple metastatic deposits in the serosal fat. (Thin arrows). (D) Malignant glands infiltrating the wall and serosal fat
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F2
Grossly, resected wedge of stomach showed a well circumscribed firm submucosal tumor (Fig. 2A) which microscopically was consistent with benign GIST (pT2pN0pM0) (Fig. 2B). Right hemicolectomy also revealed extension of tumor into the ileum with multiple tumor nodules in the mesenteric and mesocolic fat (Fig. 2C). Microscopically, a moderately differentiated adenocarcinoma originating in the sigmoid colon with infiltration into serosal fat was seen (Fig. 2D), infiltrating the ileum.