Robotic wedge resection of a rare gastric perivascular epithelioid cell tumor: A case report

Figure 1 Upper endoscopy and computed tomography gastrography findings at surgery. A: Upper endoscopy showed an ulcerative lesion of the gastric fundus with spontaneous bleeding; B: Computed tomography gastrography showed a relatively well-defined mass with ulceration of the gastric fundus, 3 cm below the esophago-gastric junction, with heterogeneous enhancement, measuring approximately 60 mm.

Figure 2 Overhead view of the operative technique. A: operative room configuration; B: da Vinci^® Si™ port layout. R: Robotic trocar; SUL: Spine-umbilical line; MCL: Midclavicular line.

Figure 3 Gross examination and histopathology. A: Polypoid lesion with central ulcer (arrow), located in the gastric wall protruding into mucosal and serous surfaces; B: Cut surface showing grayish-white; C: Microscopic sections (hematoxylin-eosin staining) of the gastric neoplasm showing both epithelioid and spindle cell components; D: 3.3’-diaminobenzidine (DAB) immunostaining for HMB-45 demonstrates positivity for epithelioid and spindle cells (arrows); E: The spindle and epithelioid cells are consistently immunopositive for smooth muscle actin following DAB immunostaining; F: Focal expression of MART-1 in the tumor cells (arrows) following DAB immunostaining. Magnification: C: 4 ×; D: 10 ×; E: 4 ×; F: 10 ×.