PMC9841066_01
Plain film of the abdomen. The long arrow shows multiple air-fluid levels, and the short arrow shows distended small bowel loops.
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FIG1
An initial abdominal X-ray was done and showed an air-fluid level with small bowel dilatation and shifting of small bowel loops to the left side of the abdomen (Figure 1).
CT scan of the abdomen. (A) Coronal view: The long arrow shows a large irregular necrotic mass (most probably a gastrointestinal stromal tumor) measuring about 17.2 x 10.7 x 18.2 cm (mediolateral x anteroposterior x craniocaudal). (B) Transverse view: The short arrows show multiple air-fluid levels at small intestine loops suggestive of small bowel obstruction.
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FIG2
No pneumoperitoneum could be noted (Figure 2).
Plain film of the chest. The arrow shows consolidation in the lower lobe of the right lung suggesting aspiration pneumonia.
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FIG3
A portable chest X-ray was done and showed consolidation in the right lower lobe, suggesting aspiration pneumonia (Figure 3).
Histopathological slides of the specimen. (A, B) Hematoxylin and eosin (H&E) stain with magnifications of x20 and x40, respectively, shows a tumor composed predominantly of spindle cells with intracytoplasmic vacuoles, moderate nuclear pleomorphism, and increased mitotic activity reaching up to 39/5 mm2. (C) Section with magnifications of x20 shows CD34 strong membranous positivity. (D) Section with magnifications of x20 shows DOG1 strong cytoplasmic and membranous positivity.
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FIG4
In addition, all the resection margins of the mass were free of tumor cells (Figure 4).