PMC4917394_01
Computed Tomography of the abdomen and pelvis (axial and coronal) showing a large gastric mass.
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A CT scan of the abdomen and pelvis was performed, displaying a 7 x 7 x 10 cm mass in the left upper quadrant, the origin of which could be either gastric or pancreatic (Fig. 1), with no evidence of metastatic disease.
Large gastric mass with bleeding ulcer on gastroscopy.
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An esophagogastroduodenoscopy (EGD) was performed showing a mass with a large bleeding ulcer adjacent to the gastroesophageal junction (GEJ)(Fig. 2).
Gastric mass near the gastroesophageal junction. Penrose drain around the esophagus.
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At the time of operation, a large gastric mass was found 3 cm from the GEJ (Fig. 3).
(A) Insular growth pattern: Nests of monomorphous, small round neuroendocrine cells without atypia or necrosis, consistent with type III gastric neuroendocrine tumor (H&E, x200 magnification). (B) Trabecular growth pattern: Tumor cells penetrate subserosa and grow in long cords one cell thick. Cytologic atypia, mitoses and necrosis are absent. (H&E, x200 magnification). (C) Small polygonal cells with round to oval nuclei, inconspicuous nucleoli and finely dispersed chromatin. Rare mitotic figures are present. (H&E, x600 magnification). (D) Ki-67 proliferative index is 7.54%, consistent with grade 2 tumor (Ki-67, x100 magnification).
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The tumor was solitary, with no endocrine cell hyperplasia or atrophic gastritis, consistent with a type III tumor (Fig. 4). Mitotic rate was 1 per 10 high power fields and Immunohistochemistry showed a Ki67 index of 7.54% assigning a grade 2 neuroendocrine tumor (G2 NET) according to the world health organization (WHO) classification (Fig. 4D).