PMC6858799_01
(A, B) Computed tomography scan depicted perijejunal mass sized 141*85 mm with central necrosis and calcification.
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The radiological report revealed a perijejunal mass sized 141*85 mm consist of a necrotic and calcific center that proposed a suspicious diagnosis of the gastrointestinal stromal tumor (GIST) and adenocarcinoma (Figure 1A and B).
(A, B) Scattered metastatic hypodense lesions in liver.
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Histopathology and immunohistochemical staining, (A) Nests and sheets of polyhedral and round cells in a scanty amount of stroma with anastomosing vascular channels (H&E, X100); (B) In some foci, the tumoral cells are loosely cohesive with a myxoid stroma (H&E, X100); (C) The tumoral cells are round to polyhedral with uniform round to oval nuclei, focal nuclear pleomorphism, indistinct nucleoli and clear to pale eosinophilic cytoplasm with anastomosing capillary-sized vascular channels in between (H&E, X400); (D) Intratumoral reticulin deposition characterized by presence of reticulin fibres around nests of the cells and between tumoral cells with a cobwebby pattern(Reticulin stain, X100); (E) Diffuse cytoplasmic immunoreactivity of the tumoral cells for vimentin(Immunostaining, Anti-VimentinAb, X100); (F) Scatteredtumor cells show positive cytoplasmic reactivity for smooth muscle actin(Immunostaining, Anti Sm-Actin Ab, X400); (G) Immunostaining for CD34 highlights branching vascular channels(Immunostaining, Anti-CD34 Ab, X100); (H) Low proliferation capacity of the tumoral cells(Immunostaining for Ki67, MIB-1 clone, X400).
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Histopathologically, the abdominal mass composed of cellular tissue formed by branching vascular channels separated by stroma containing, nests and sheets of polyhedral to spindle cells with uniform round to oval nuclei, focal pleomorphism, some distinct nucleoli and pale to eosinophilic cytoplasm which in some foci entrapped in a fibrous stroma showing marked nuclear atypia (Figure 3A-C). Reticulin staining showed positive intratumoral reticulin deposition with a cobwebby appearance (Figure 3D). Ki67 were positive in up to 10% of tumoral cells (Figure 3E-H).
Enhanced abdominopelvic computed tomography demonstrated lymph nodes involvement (A) Pancreaticoduodenal lymph node metastasis; (B) Paraaortocaval lymph node metastasis.
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