Menu

Case of the Month: April 2021

A 71-year-old female presented with dysphagia, intermittent left upper abdominal pain, and unintentional weight loss of approximately 7 lbs. over 4 months. (pdf link below)

Case

An abdominal CT scan with contrast demonstrated an 8.5 x 6.0 x 5.5 cm solid, well-marginated mass along the fundus of the stomach, extending to the gastroesophageal junction (Figure 1). Upper gastrointestinal endoscopy showed a large subepithelial gastric mass with no bleeding or ulceration of the mucosa located in the cardia/fundus of the stomach (Figure 2). EUS revealed a hypoechoic subepithelial gastric mass in the cardio-fundic region which appeared to originate from the muscle layer of the stomach wall. Fine needle aspiration and biopsy were performed (Figure 3) followed by a proximal gastrectomy. The gross photo and microscopic findings are shown below (Figure 4-5).

Abdominal CT scan demonstrating an 8.5 cm solid, well-marginated mass with non-homogeneous contrast enhancement along the fundus of the stomach extending to the gastroesophageal junction.

Endoscopic picture of intact gastric mucosa with bulging subepithelial mass in the cardia/fundus of the stomach visible on retroflexion view.

3A: FNA of submucosal lesion showing a few aggregates of cytologically bland spindle cells with myxoid background.

3B: Immunohistochemical stain for β-catenin shows strong and diffuse nuclear and cytoplasmic labeling in the tumor cells.

Cross section of the resected gastric mass reveals a well-demarcated intramural heterogenous mass with discrete contours. The overlying mucosa (upper portion of the picture) and the serosal surface (lower portion of the picture) are both intact. Esophageal-gastric junction is on the left side of the picture.

5A: High-power view of the central area of the lesion demonstrating a hypercellular storiform pattern of spindle cells with moderate nuclear pleomorphism and inconspicuous nucleoli.

Intermediate-power of hypocellular area from the periphery of the mass demonstrating spindle cells in a myxoid background containing dilated blood vessels with a staghorn pattern.

5C: Immunohistochemical stain for CD117 is negative.

5D: Immunohistochemical stain for β-catenin shows cytoplasmic and strong nuclear labeling in the tumor cells.

Membership Application

Not A Member?

GIPS members have access to Journal Watch, Case of the Month, job and fellowship listings, and more! >>>LEARN MORE

GIPS Awards

Congratulations to Dr. Anirban Maitra, recipient of the 2021 Jack... Read more

Congratulations to Dr. Thomas Smyrk, recipient of the 2021 Harvey... Read more

Abstract Award Winner: Alex Taylor, University of Michigan: Measuring Submucosal... Read more

Congratulations to Dr. Stanley Hamilton, recipient of the 2020 Harvey... Read more

Congratulations to Dr. Reet K. Pai, recipient of the 2020... Read more