Presentation
Gastric mass discovered at gastroscopy.
Patient Data
Ulcerated mass in the small gastric curvature, apparently extending to the cardia and featuring the Torricelli-Bernoulli sign.
Slightly enlarged gastrohepatic lymph nodes up to 8 mm thick.
Case Discussion
The Torricelli-Bernoulli sign, in this case, denotes an air-fluid level in the ulcer crater due to trapping of air when the patient changes position from upright to supine.
Pathology report as follows:
MACROSCOPIC DESCRIPTION:
A stomach was received measuring: small curvature 15 cm long, large curvature 24 cm long.
Located 4 cm from the proximal end and 9 cm from the distal end is a brown, ulcerated area with a raised rim measuring 4.5 x 4 x 2 cm. The rest of the mucosa is granulated.
On dissection of the fatty tissue, lymph nodes with a diameter of 0.4-2 cm were found.
Additionally, two anastomotic rings with a diameter of 1.5 cm and 2 cm.
Attached to the preparation is an omentum measuring 30 x 28 x 1.5 cm. Dissection showed no masses.
MICROSCOPIC DESCRIPTION:
Diagnosis:
Total gastrectomy shows ulcerated gastric stromal tumor (GIST), measuring 4.5 cm in maximum diameter, positive for c-kit and CD34 markers with a mitotic rate of 5 mitoses/50 HPF.
Ki-67 stain shows a proliferative index of about 5%/50 HPFs.
No vascular involvement.
The surgical margins are free of tumor.
Both anastomotic rings and the omentum are free of tumor.
26 regional lymph nodes were examined, all free of tumor.
Note:
Based on tumor size and the mitotic rate, the tumor belongs to group 2 (size >2 <=5 cm and mitotic rate <=5/50 HPFs) with a very low risk (1.9%) for progressive disease/risk for metastasis.
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