PMC9937071_01
CT scan showing gastric perforation (red arrow) and pneumoperitoneum in (a): axial section and (b): sagittal section.
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An abdominal computed tomography (CT) scan was then requested, evidencing pneumoperitoneum and gastric mucosal enhancement with a clear stop in continuity in the greater curvature prior to the antropyloric junction with no other abnormal findings (Figure 1a and b).
Exploratory laparoscopy evidencing massive perforation of the anterior wall of the gastric antrum.
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Exploratory laparoscopy was performed evidencing a 4-quadrant peritonitis secondary to a 5 cm perforation at the antropyloric junction caused by a necrotic malignant tumour (Figure 2).
Resected specimen evidencing an ulcerated whitish tumour of 5.6 x 3.8 cm. The lesion involved and perforated the gastric wall with extension into the serosa.
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The lesion involved and perforated the gastric wall with extension into the serosa (Figure 3).
(a): Histological section (H&E - Magnification 40x). The left portion of the image shows mucosal ulceration with a dense tumour cell infiltration underneath. The right half shows adjacent mucosa with expansion of lamina propria by medium-to-large size moderately pleomorphic cells. (b): Histological section (H&E - Magnification 400x) Neoplastic T cells form a dense, moderately pleomorphic infiltrate, medium to large in size with round or angled nuclei and prominent nucleoli. Frequent mitotic figures are observed. There is a component of inflammatory cells, including histiocytes and eosinophils.
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The histological sections of material, embedded in paraffin and coloured with haematoxylin and eosin, showed a neoplastic proliferation of diffuse medium to large cells with abundant cytoplasm and round or angulated nuclei, accompanied by a pronounced and polymorphic inflammatory background and extensive areas of necrosis (Figure 4).
Immunostaining results.
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Staining for CD30, CD4, CD5, CD56, anaplastic lymphoma kinase-1 and keratin cocktail (AE1AE3) as well as B-cell differentiation markers (CD20, PAX5 and CD138) was found to be negative (Figure 5).