The patient was a 72-year old female. She was admitted on 17th November, 2011 with upper abdominal discomfort for 4 d, accompanied by postprandial nausea and vomiting. She denied chills, fever, or diarrhea. Her medical and family history were noncontributory.
Physical examination: temperature 37.5 °C, pulse 90 bpm, respiration 20 bpm, blood pressure 172/96 mmHg. The heart and lungs were normal. The abdomen was flat and soft, with tenderness below the xiphoid process. No enlarged liver, spleen, or mass was palpable. Murphy’s sign was negative. Laboratory and radiology findings: Routine blood work showed white blood cell 12.7 × 109/L, neutrophils 85.3%. Liver function tests were in normal range. Fasting blood glucose was 8.88 mmol/L. Adrenocorticotropic hormone was in normal range. On B-ul-trasonography, the gallbladder was 64 mm × 37 mm. The gallbladder wall was thickened, with a stone incarcerated in the neck. Computed tomography (CT) scan showed a 15 mm × 25 mm abnormal enhanced nodule located in the submucosa of the lesser curvature of the stomach with a CT value of 150 HU. The size, morphology, and location of the kidneys and adrenal glands were normal bilaterally, and there were multiple cysts in both kidneys. The radiological diagnoses were multiple renal cysts and a gastric stromal tumor (Figure ). Fibergastroscopy showed no hyperemia in the gastric mucosa. A raised nodule about 30 mm × 25 mm in size was found on the lesser curvature side of the gastric antrum; it was firm with soft mucosa. The endoscopic diagnosis was also a gastric stromal tumor (Figure ). After adequate preparation, the patient underwent surgery. During the operation, we found a distended gallbladder with a stone inside. There was a 30 mm × 30 mm mass with medium density in the lesser curvature near the gastric antrum and the mass located in the serosa layer. The liver, spleen, pancreas, kidney, and adrenal glands were normal. We resected the gallbladder, ligated the vessels of lesser gastric curvature, and opened the gastric wall 3 cm from the margin of the mass. We found that the gastric mucosa above the mass was integrated, and we performed a simple resection of the mass. On gross examination, the mass was purplish-red in color. It was a 20 mm × 30 mm ellipse with soft margins and a medium texture (Figure ). On microscopic exam, the tumor cells were rich in cytoplasm and eosinophilic, and numerous sinusoid capillaries could be seen. The cytoplasm contained melanin, which was confirmed by decolorization. The tumor cells were arranged in cords or gobbets with a low ratio of nucleus to cytoplasm, and rare mitotic figures (Figure ). Immunohistochemistry: S-100 basement cell negative (Figure ), melan-A positive (Figure ), P63 basement cell negative, sinusoidal endothelial CD34 positive (Figure ). The pathologic diagnosis was of an ectopic adrenal cortical adenoma in the gastric wall.
Enhanced image of nodule located in the lesser gastric curvature.
Elevated nodule on the lesser curvature side of the gastric antrum.
Analysis of tumor cells. A: Gastric wall mass, approximately 20 mm × 30 mm in size; B: Tumor cells under low power magnification; C: Tumor cells under high power magnification.
Immunohistochemistry. A: S-100 basement cell negative; B: Melan-A positive; C: CD34 positive.