PMC10392777_01
(A) An axial section of the computed tomography of the abdomen shows a poorly unenhanced and enlarged spleen with its destructed structure, accompanied by bulky thrombosis in the splenic vein near the hilum of the spleen (arrows), in addition to perihepatic and perisplenic bloody ascites. (B) Interventional radiology of the celiac trunk shows diffusely attenuated staining of the spleen with no extravasations. (C) A diffusion-weighted magnetic resonance imaging of the brain demonstrates an extensive high-intensity area in the left middle cerebral artery (MCA) region, suggesting acute brain infarction. (D) A magnetic resonance angiography depicts disruption of left MCA at the M1 level and no distal blood flow. Emergency interventional radiology has successfully been performed to remove the thrombus from the area.
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Interventional radiology (IVR) of the celiac trunk showed attenuated staining of the spleen with no extravasations (Figure 1A,B). These modalities revealed extensive infarction of the left cerebrum and emergency IVR removed the embolus in the left mid-cerebral artery (Figure 1C,D).
(A) The surface, (B) the hilar side, and (C) a cut surface of the resected spleen are shown. The size of the spleen is 140 x 75 x 50 mm, and its surface has a few lacerations. The main splenic vein and its branches around the hilum are remarkably dilated and congested with thrombosis. (D,E) The hematoxylin and eosin-stained specimen from the spleen in x4 (D) and x40 (E) magnification. (F,G) The Alcian blue-PAS stained specimen from the spleen in x4 (F) and x40 (G) magnification. Most of the cells are devoid of nuclei, but some of them have eccentrically located nuclei. Atypical cells suggest metastatic signet-ring cell carcinoma with remarkable degeneration, presumably because of congestion or infarction. (H,I) The elastin van Gieson stained (H) and AE1/AE3 stained (I) specimen of the thrombus in the splenic vein in x2 magnification, which is composed of fibrin, blood clots, and fibrous connective tissues with no carcinomatous cells.
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The thrombus in the splenic vein was composed of fibrin, blood clots, and fibrous connective tissues with no carcinomatous cells (Figure 2).
Endoscopic examination reveals normal gastric mucosa in (A) the lesser curvature of the gastric body, (B) the antrum, and (C) the greater curvature of the gastric body except for some elevated erosive lesions. A biopsy was performed for the erosive lesions of the gastric mucosa. (D,E) Two of five specimens showed signet-ring carcinoma cells in the mucosa of the stomach, mainly in the lamina propria. (x10 [D] and x40 [E] magnifications with hematoxylin and eosin-stained).
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Carcinoma cells were observed mainly in the lamina propria (Figure 3).