19860007 Visualization

A 70 Age - year Age - old Age man Sex was referred Clinical_event to our hospital Nonbiological_location for gastric Biological_structure cancer Disease_disorder that was detected during screening by esophagogastroduodenoscopy Diagnostic_procedure (EGD) Diagnostic_procedure .
No History significant History medical History history History was identified, except dysuria Sign_symptom caused Detailed_description by Detailed_description bladder Detailed_description contraction Detailed_description .
Initial laboratory Diagnostic_procedure data showed a serum Diagnostic_procedure level Diagnostic_procedure of Diagnostic_procedure AFP Diagnostic_procedure of 32.3 Lab_value ng/mL Lab_value (normal range: 0-15 ng/mL), but no Lab_value other Lab_value abnormality Lab_value , which included other tumor markers, such as, carcinoembryonic Diagnostic_procedure antigen Diagnostic_procedure (CEA) Diagnostic_procedure and carbohydrate Diagnostic_procedure antigen Diagnostic_procedure 19 Diagnostic_procedure - 9 Diagnostic_procedure (CA19 Diagnostic_procedure - 9) Diagnostic_procedure .
EGD Coreference revealed a 5 Distance - cm Distance ulcerofungating Detailed_description mass Sign_symptom that was comprised Detailed_description of Detailed_description three Detailed_description septate Detailed_description ulcers Detailed_description in Biological_structure the Biological_structure greater Biological_structure curvature Biological_structure of Biological_structure the Biological_structure gastric Biological_structure antrum Biological_structure .
A pathological Diagnostic_procedure examination Diagnostic_procedure of endoscopic Biological_structure biopsy Biological_structure tissues Biological_structure confirmed the presence of moderately Detailed_description differentiated Detailed_description tubular Detailed_description adenocarcinoma Disease_disorder .
Subsequent abdominopelvic Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure visualized a gastric Biological_structure mass Sign_symptom with Detailed_description deep Detailed_description ulceration Detailed_description in Biological_structure the Biological_structure gastric Biological_structure antrum Biological_structure with Detailed_description perigastric Detailed_description lymph Detailed_description node Detailed_description enlargement Detailed_description .
No metastatic Sign_symptom lesions Sign_symptom were observed in the liver Biological_structure , lung Biological_structure or peritoneum Biological_structure , and chest Biological_structure radiography Diagnostic_procedure showed no Sign_symptom significant Sign_symptom findings Sign_symptom .
Radical Detailed_description subtotal Detailed_description gastrectomy Therapeutic_procedure with D2 Biological_structure lymph Biological_structure node Biological_structure dissection Therapeutic_procedure and Billroth Detailed_description II Detailed_description gastrojejunostomy Therapeutic_procedure were performed.
Grossly, the resected Biological_structure specimen Biological_structure contained double Lab_value lesions Sign_symptom : the first was a Detailed_description 5.8 Detailed_description cm Detailed_description × Detailed_description 3.2 Detailed_description cm Detailed_description ulcerofungating Detailed_description mass Detailed_description in Detailed_description the Detailed_description antrum Detailed_description , with extensive Detailed_description hemorrhage Detailed_description and light Color gray Color fibrosis Detailed_description ; and the second was a Detailed_description nearby Detailed_description 2.5 Detailed_description cm Detailed_description × Detailed_description 2.0 Detailed_description cm Detailed_description ulcerative Detailed_description lesion Detailed_description (Figure ​1).
Microscopically, massive Lab_value numbers Lab_value of pleomorphic Detailed_description , bizarre Detailed_description tumor Sign_symptom cells Sign_symptom with hemorrhage Detailed_description (syncytiotrophoblasts Detailed_description and Detailed_description cytotrophoblasts) Detailed_description were observed in the first lesion.
Hematoxylin Diagnostic_procedure and Diagnostic_procedure eosin Diagnostic_procedure (HE)-stained tissues Diagnostic_procedure revealed a bubbly Shape purple Color cytoplasm Biological_structure and giant Lab_value nuclei Biological_structure at a magnification Detailed_description of Detailed_description 40 Detailed_description × Detailed_description (Figure ​2A) and 100 Detailed_description × Detailed_description (Figure ​2B).
The tumor Coreference involved the proper Biological_structure muscle Biological_structure layer Biological_structure (T2a) Biological_structure and metastasis Sign_symptom was found in Biological_structure four Biological_structure of Biological_structure 56 Biological_structure regional Biological_structure lymph Biological_structure nodes Biological_structure (N1).
Immunohistochemical Diagnostic_procedure staining Diagnostic_procedure showed positive Lab_value immunoreactivity Lab_value for β Diagnostic_procedure - human Diagnostic_procedure chorionic Diagnostic_procedure gonadotropin Diagnostic_procedure (HCG) (Figure ​3A) and focal Lab_value positivity Lab_value for AFP Diagnostic_procedure (Figure ​3B).
These findings confirmed the presence of gastric Biological_structure choriocarcinoma Disease_disorder that contained small foci of an AFP Detailed_description - producing Detailed_description adenocarcinoma Disease_disorder .
The second lesion was moderately differentiated tubular Biological_structure adenocarcinoma Disease_disorder , which extended Biological_structure to Biological_structure the Biological_structure submucosal Biological_structure layer Biological_structure (T1b).
It was close to, but distinct from the first lesion, which was negative by immunohistochemical staining for β-HCG and AFP.
The patient had an uneventful Lab_value postoperative Therapeutic_procedure course Therapeutic_procedure and was discharged Clinical_event on postoperative Date day Date 9 Date .
Two Date weeks Date later Date , his HCG Diagnostic_procedure level Diagnostic_procedure was 176 Lab_value mIU/mL Lab_value (normal range: 0-10 mIU/mL) and his AFP Diagnostic_procedure level Diagnostic_procedure was 10.0 Lab_value ng/mL.
Six Frequency cycles Frequency of adjuvant Medication chemotherapy Medication with capecitabine Medication (Xeloda; Hoffmann-La Roche Inc., Nutley, NJ, USA) was started at 2500 Dosage mg/m2 Dosage per Dosage day Dosage for Dosage 14 Dosage d/cycle Dosage .
After Date two Date cycles Date , his β Diagnostic_procedure - HCG Diagnostic_procedure level Diagnostic_procedure had declined Lab_value to < Lab_value 3 Lab_value mIU/mL Lab_value , and has since remained at this level.
No recurrence Sign_symptom or distant Sign_symptom metastasis Sign_symptom had occurred at his 4 Date - year Date postoperative Clinical_event follow Clinical_event - up Clinical_event .