Synchronous gastric cancer complicated with chronic myeloid leukemia (multiple primary cancers): A case report

Figure 1 The patient’s karyotype is 46, XY, t (9;22) (q34;q11). A: The typical translocation between the chromosomes 9 and 22 was found in all 20 metaphase cells analyzed; B-D: Bone marrow smear shows an extremely active cellular proliferation, myeloid cells that are dominated by myelocytes and metamyelocytes, and easily observable/high rate of eosinophils and basophils.

Figure 2 Computed tomography images show gastric cancer. A: Computed tomography (CT) in venous phase show edematous and thickened gastric wall; B: CT in the arterial phase, the gastric wall was thickened and significantly enhanced.

Figure 3  Emission computed tomography images show abnormal bone metabolism in the bilateral scapulae, ribs, and ilium; multiple bone metastases were considered.

Figure 4 Gastroscopic images show gastric cancer (Bowman type IV). A: A large amount of retained material in the gastric cavity and huge ulcers in the lower part of the gastric body, angle, and antrum; B: The ulcers base is uneven, brittle, and easy to bleed. Local peristalsis has disappeared.

Figure 5 Pathological examination after gastroscopic biopsy reveals the presence of a small number of atypical cells. A-C: Hematoxylin-eosin staining of biopsy specimens indicate poorly differentiated adenocarcinoma (A, 40 ×; B, 40 ×; C, 100 ×); D-F: Immunohistochemical staining shows that the specimens are positive for CKL (D, 200 ×), and Ki-65 (E, 200 ×) and negative for Her-2 (F, 200 ×).

Figure 6 Computed tomography images. A: Computed tomography images show significantly thickened gastric wall; B: The tumor has invaded the hepatic flexure of the transverse colon, resulting in marked dilation of the upper bowel.

Figure 7 Histopathological examination shows a small mesenteric nodule, likely metastatic adenocarcinoma. A: Hematoxylin-eosin stain: 40 ×; B: Hematoxylin-eosin stain: 100 ×.