PMC5288507_01
Case  1. The gastric resection specimen's (a) cut surface (b) revealed a grey to tan colored, friable lesion with a necrotic center. Scale bar = 1 cm. A submucosal, multinodular, "bubbly" lesion with accompanying chronic inflammatory infiltrate was noted ((c) x10, hematoxylin-eosin).
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fig1
The cut section of this 5 x 3 x 1.5 cm-sized gastric resection specimen revealed a poorly circumscribed white lesion, 1.5 cm in diameter, that spanned the whole gastric wall except for the mucosa, with grey-white necrotic material in its center (Figures 1(a) and 1(b)). The mucosa was intact; the lesion spanned the submucosa and destroyed the muscularis propria, reaching the serosa (Figure 1(c)).
The lesion in Case 1 consisted of multinucleated giant cells surrounding clear appearing cystic spaces ((a) x20). Slight dimming of the light source on one side revealed translucent material rimming these spaces ((b) x20).
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Closer inspection revealed translucent, wispy material that rimmed the spaces giant cells had encircled (Figure 2(a)). This material did not fully refract polarized light, but slight dimming of the light source made the material more visible, rendering the material "slightly refractile" (Figure 2(b)).
PMC5288507_02
Case 2 consisted of a hemorrhagic mucosal tissue with multiple small spaces and chronic inflammation in lamina propria ((a) x2). Mucosal glands were disrupted by nodules of foreign body type giant cells surrounding vaguely globoid spaces; hemosiderin (brown pigment, arrowhead) was visible in nearby cells ((b) x40). Gastric glands and giant cells displayed siderosis ((c) Prussian Blue, x10).
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Beneath the intact part of the epithelium, there were extravasated erythrocytes (Figure 3(a)). Lymphocytic aggregates and lymphoplasmacytic inflammatory reaction were also seen (Figure 3(b)). Prussian Blue staining displayed siderosis in giant cells and gastric glands (Figure 3(c)).
PMC5288507_03
Case 3 demonstrated a trace of a vessel (arrow) that was engorged with cyanoacrylate, here seen as a trace of cystic-globoid structures ((a) x10). Closer view of these structures showed multinucleated giant cells around the spaces (arrowhead) and chronic inflammatory reaction (arrow) in lamina propria ((b) x20).
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An inflammatory reaction composed of eosinophils and lymphoid aggregates was detected (Figures 4(a) and 4(b)). The paucity of the remaining tissue precluded additional studies to prove the presence of an endothelial lining, but the pathogenesis and the curvilinear orientation of the lesion both support the presence of an involved vessel in this particular case (Figure 4(a)).