PMC2946604_01
(a) Gastroscopy showed a round tumor at the anterior wall of the gastric body. (b) The resected tumor was 2 cm in diameter.
CRM2010-348761.001.jpg
PMC2946604_01_CRM2010-348761.001.jpg
fig1
A round tumor was detected at the anterior wall of the middle gastric body, and biopsy revealed a carcinoid (Figure 1(a)). The tumor was 2 cm in diameter (Figure 1(b)) with involvement of the muscularis propria (Figure 2(a)).
(a) Histological examination of the partially resected tumor revealed carcinoid with muscularis propria involvement (H&E x4). (b) Carcinoid was consisted of uniform cells with round-shaped nuclei with ribbon-like structure (H&E x40). (c), (d) The tumor cells showed immunoreactivity for synaptophysin (synaptophysin, (c) x4, (d) x40).
CRM2010-348761.002.jpg
PMC2946604_01_CRM2010-348761.002.jpg
fig2
The tumor was 2 cm in diameter (Figure 1(b)) with involvement of the muscularis propria (Figure 2(a)). These uniform cells (Figure 2(b)) were strongly positive for chromogranin A and synaptophysin (Figures 2(c) and 2(d)).
(a) Follow-up gastroscopy revealed another polypoid lesion in the residual stomach. (b) Resected whole stomach. (c) Numerous endocrine cell micronests (arrows) were observed widely in the muscularis mucosae of the stomach (H&E, x4).
CRM2010-348761.003.jpg
PMC2946604_01_CRM2010-348761.003.jpg
fig3
Seven months later, follow-up gastroscopy revealed another polypoid lesion in the residual stomach (Figure 3(a)). Total gastrectomy was performed (Figure 3(b)), and microscopic evaluation showed numerous endocrine cell micronests (ECMs; size: 0.1~1.75 mm), which were diffusely observed in the stomach (Figure 3(c)).
PMC2946604_02
(a) Gastroscopy revealed multiple elevated lesions at the whole stomach. (b) Pathological analysis of the tumors after antrectomy showed carcinoid consisted of uniform cells with round-shaped nuclei with rosette-like or nodular solid structure (H&E x40), (c) with submucosal invasion (H&E x4). (d) The tumor cells were positive for chromogranin A staining (chromogranin A x4).
CRM2010-348761.004.jpg
PMC2946604_02_CRM2010-348761.004.jpg
fig4
Gastroscopy revealed lots of elevated lesions (all were less than 5 mm in diameter) in the whole stomach (Figure 4(a)), and the biopsy showed a carcinoid. Pathological analysis showed that the resected tissue was a carcinoid (Figure 4(b)) with invasion into the submucosa (Figure 4(c)). The tumor cells were positive for chromogranin A (Figure 4(d)) and synaptophysin.
Background gastric mucosa of the resected stomach was type A gastritis microscopically. (a) Atrophy of gastric glands in the mucosa of gastric body was shown (H&E x4). (b) In the mucosa of antrum, no apparent atrophy of the pyloric glands was observed (H&E x4). (c) Hyperplasia of gastrin-producing cells was detected (arrows) (gastrin staining x4).
CRM2010-348761.005.jpg
PMC2946604_02_CRM2010-348761.005.jpg
fig5
Type A gastritis was observed under the background of gastric mucosa of the antrectomy specimen, which was characterized by atrophic gastric glands of gastric body and decreased number of parietal cells (Figure 5(a)). In the mucosa of antrum, no apparent atrophy of the pyloric glands (Figure 5(b)) and hyperplasia of gastrin-producing cells were detected (Figure 5(c)).
PMC2946604_03
(a) Gastrcosopy revealed a large gastric tumor near the esophagogastric junction. (b) Total gastrectomy was performed, and the resected tumor was approximately 8 cm in diameter.
CRM2010-348761.006.jpg
PMC2946604_03_CRM2010-348761.006.jpg
fig6
Gastroscopy revealed a large gastric tumor near the esophagogastric junction (Figure 6(a)), and biopsy showed poorly differentiated adenocarcinoma with ECL cell tumor (carcinoid). After blood transfusion, total gastrectomy was performed (Figure 6(b)) with regional lymphadenectomy.
(a), (b) Microscopic findings of the resected specimen revealed that the tumor was comprised of poorly differentiated adenocarcinoma ((a) H&E x40) with components of ECL cell carcinoid ((b) H&E x40). (c) Carcinoid, immunohistochemically positive for chromogranin A staining (arrows), diffusely intermingled with adenocarcinoma (chromogranin A x4). (d) Both carcinoid and adenocarcinoma invaded to subserosa (H&E x4).
CRM2010-348761.007.jpg
PMC2946604_03_CRM2010-348761.007.jpg
fig7
Histological examination of the resected specimen revealed that the tumor was composed of poorly differentiated adenocarcinoma (Figure 7(a)) with components of ECL cell tumors (Figure 7(b)). These ECL cell tumors were diagnosed as carcinoid because they were immunohistochemically positive for chromogranin A (Figure 7(c)) and synaptophysin, and the cell size was larger than small cell carcinoma. The carcinoid diffusely intermingled with adenocarcinoma and invaded into the subserosa (Figure 7(d)).