PMC6317839_01
Endoscopic image of the stomach showing a large submucosal lesion with overlying ulceration in the gastric body.
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F1
An esophagogastroduodenoscopy (EGD) performed at another hospital revealed a 9-cm submucosal lesion with overlying ulceration in the body of the stomach (Figure 1).
Gross picture showing a large submucosal tumor of stomach, a mass with overlying mucosa (star), and adjacent normal gastric mucosa (white arrow). The inset shows a yellow cut surface with gray and white areas and prominent vessels (arrow).
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F2
Gross examination of the subtotal gastrectomy specimen showed a large polypoidal circumscribed mass measuring 9 x 6 x 5 cm in the anterior wall of the stomach, with central mucosal ulceration and hemorrhage (Figure 2). The cut surface of the tumor was pale yellow, with gray-white areas and few thickened blood vessels (Figure 2).
(A) Hematoxylin and eosin (H&E) stain (50x) showing gastric submucosal lipomatous tumor cells with mucosal ulceration. Inset shows source of bleeding (arrow). (B and C) H&E stain (100x) of triphasic component of tumor comprising adipocytes (arrow with star), thick-walled vessel (black arrow), and smooth muscle emanating from the vessel (arrow with #). (D) Smooth muscle actin stain (100x) highlighting smooth muscles emanating from the vessel wall (arrow).
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F3
Immunohistochemical studies showed positive expression of S100, SMA, and desmin in the spindle cells and negative expression for HMB45 and ER (Figure 3).