Residual gastric cancer with a mixed small cell neuroendocrine and keratinizing squamous cell carcinoma: A case report

Figure 1 Endoscopy, endoscopic ultrasound and pathologic findings in our hospital. A and B: Endoscopy shows a prominent lesion in the remnant stomach; C and D: Tumor manifestations observed through endoscopic ultrasound; E: Histological findings of hematoxylin and eosin (100 × on the left, 200 × on the right).

Figure 2 Pre-operation abdominal computed tomography images and positron emission tomography-computed tomography. A and B: Abdominal computed tomography (CT) revealed the gastric wall at the greater curvature of remnant stomach were obviously thickened; C and D: Enhanced CT revealed the gastric wall at the greater curvature of remnant stomach were obviously thickened; E: Positron emission tomography-CT showed metabolism nodular thickening of the residual gastric wall, enlarged lymph nodes beside the abdominal aorta (at the T12 level) and in the middle abdomen (at the L2 level).

Figure 3 The histological examination and immunohistochemical profiling of the surgically resected tissue. A: Results of hematoxylin and eosin staining; B: The expression of marker proteins specific for small cell neuroendocrine carcinoma; C: Immunohistochemical results for P40 and cytokeratin 5/6 protein expression; D and E: The expression of mismatch repair protein-related indicators postmeiotic segregation increased 2, mutS homolog 6, mutL homolog 1, mutS homolog 2, as well as the expression of tumor protein P53 and Ki67. SSTR2: Somatostatin receptor type 2; SYN: Synaptophysin; TTF-1: Thyroid transcription factor-1; CgA: Chromogranin A; CD56: Cluster of differentiation 56. MLH1: MutL homolog 1; MSH6: MutS homolog 6; MSH2: MutS homolog 2; PMS2: Postmeiotic segregation increased 2.

Figure 4 Endoscopy and pathologic findings in another hospital. A: Endoscopy shows a prominent lesion in the remnant stomach; B: Histological findings of hematoxylin and eosin (100 ×); C: Histological findings of hematoxylin and eosin (200 ×).