PMC1180859_01
Microscopic photograph of the biopsied specimen. A. Bland glands mimicking benign foveolar epithelial hyperplasia are noted in the heavy inflammatory backgrounds (hematoxylin and eosin, X400). B. Glands are destructed by inflammatory cell infiltrates and epithelial cells reveal mild atypia (hematoxylin and eosin, X400).
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F1
Microscopically the biopsy specimen showed proliferations of bland looking hyperplastic foveolar epithelia with basally located small nuclei and fine nuclear chromatin in the heavy inflammatory background (Figure 1A). Some glands were destructed by inflammatory cell invasion and revealed mild epithelial atypia with mildly increased nuclei and loss of nuclear polarity reminiscent of reactive cellular atypia (Figure 1B).
Macroscopic photograph of the tumor. A. Resected stomach reveals huge fungating tumor at the cardia. B. The cut surface of the tumor is whitish gelatinous and the tumor involves the whole layer of the gastric wall.
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F2
The resected stomach revealed a huge fungating tumor (Borrmann type 1) at the cardia (Figure 2A). The cut surface of the tumor was whitish gelatinous and the tumor involved the whole layer of the gastric wall (Figure 2B).
Low power view of microscopic photograph of the tumor. A. Tumor glands proliferate haphazardly with papillary configuration at the surface (hematoxylin and eosin, X40). B. Cystically dilated glands invade to proper muscle and subserosa (hematoxylin and eosin, X40).
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F3
Microscopically the tumor was sharply demarcated from surrounding mucosa and composed of proliferations of deceptively bland glands lined by mucin-rich columnar cells with small basal nuclei (Figure 3A). Many glands are cystically dilated especially in deep portion and their glandular lumina were filled with abundant mucin (Figure 3B).
High power view of microscopic photograph of the tumor. A. Bland glands are lined by mucin-rich columnar cells with basal nuclei (hematoxylin and eosin, X400). B. More complicated glands are lined by more atypical nuclei with prominent nucleoli (hematoxylin and eosin, X400). C. Very benign looking glands are present within muscle (hematoxylin and eosin, X400). D. Metastatic tumor glands within lymph node show insignificant cellular atypia (hematoxylin and eosin, X400).
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F4
Most of glands were too bland to discriminate from benign foveolar epithelial hyperplasia (Figure 4A and 4C), but some glands were more complicated or branched with mild to moderate cellular atypia revealing increased nuclei with loss of polarity and prominent nucleoli (Figure 4B). Metastatic tumor cells within regional lymph nodes were also very bland (Figure 4D).
Immunohistochemical finding of the tumor. The tumor cells and intraluminal mucin are diffusely expressed MUC1 (A) and MUC5AC (B). MUC2 expression is focally noted in some tumor cells (C). Tumor cells reveal high Ki-67 labeling index (D). (Immunohistochemistry, X100).
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F5
IIIA (T3N1M0). Immunohistochemically the tumor cells revealed no overexpression of p53 protein but high Ki-67 labelling index suggesting high proliferative activity (Figure 5D). MUC1 (Figure 5A) and MUC5AC (Figure 5B) suggesting gastric foveolar phenotype. MUC2 expression was only focally detected (Figure 5C).