PMC3617895_01
a Computed tomography of the abdomen demonstrated an enhanced extramural tumor of the stomach that was 4 cm in diameter (arrows). b Endoscopic examination revealed a jejunal submucosal tumor.
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F1
Computed tomography of the abdomen demonstrated an enhanced extramural tumor of the stomach, 4 cm in diameter (fig. 1a), but did not indicate a jejunal tumor. Endoscopic examination revealed a jejunal submucosal tumor (fig. 1b), but could not identify the gastric lesion.
a A nut-sized extramural tumor was identified at the lesser curvature of the middle stomach (arrows). b A thumb's head-sized tumor was also identified at the jejunum about 15 cm from the anal side of the Treitz ligament (arrows).
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F2
Laparotomy revealed a nut-sized extramural tumor at the lesser curvature of the middle stomach (fig. 2a) that was white-yellow, elastic soft and had dilated vessels on the surface. Treitz ligament (fig. 2b).
Histopathological examination with hematoxylin and eosin staining of the gastric GIST (a, x400) and the jejunal GIST (b, x400) and immunohistochemical staining patterns of the gastric (c, e, g, i, x400) and jejunal (d, f, h, j, x400) GISTs. The gastric GIST was positive for c-kit (c), CD34 (e) and NSE (i), but negative for SMA (g). On the other hand, the jejunal GIST was positive of c-kit (d), SMA (h) and NSE (j), but negative for CD34 (f).
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F3
Histopathological examination with hematoxylin and eosin staining revealed that the gastric tumor was composed of a proliferation of spindle cells with spindle nuclei and eosinophilic fibrillar cytoplasm, arranged in fascicles with a hypercellular area (fig. 3a), and the jejunal tumor contained a proliferation of spindle cells with oval or spindle nuclei and occasional pleomorphic cells, arranged in a fascicular or haphazard fashion, alternating with areas of epithelioid features (fig. 3b). The gastric tumor was positive for c-kit (fig. 3c), CD34 (fig. 3e) and neuron-specific enolase (NSE) (fig. 3i), but negative for smooth muscle actin (SMA) (fig. 3g). On the other hand, the jejunal tumor was positive of c-kit (fig. 3d), SMA (fig. 3h) and NSE (fig. 3j), but negative for CD34 (fig. 3f).