Gastroblastoma without GLI1 and EWSR1 gene breaks

Gastroblastoma without GLI1 and EWSR1 gene breaks | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Gastroblastoma without GLI1 and EWSR1 gene breaks Can Gong, Jun yi Xu, Shu ye Qiao, Xue mei Zhang, Min Yi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2739475/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Sep, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted 10 You are reading this latest preprint version Abstract Gastroblastoma (GB),a newly discovered gastric tumor with epithelial and diaphthytal differentiation,was first reported in 2009 by Miettinen et al. So far,a total of 17 cases have been reported in domestic and foreign literature,of which 13 cases were reported in the English literature,4 cases were reported in the Chinese literature,6 of 17 cases had confirmed MALAT1-GLI1 fusion gene;1 case found EWSR1-CTBP1 fusion gene. WHO (2019) included the classification of digestive system tumors for the first time. Because gastroblastoma is very rare and has a bidirectional differentiation in morphology,the differential diagnosis of them with other bidirectional tumors of the stomach (such as synovial sarcoma and sarcomatoid carcinoma) and various gastric tumors characterized by relatively mild epithelioid or spindle cells has become very difficult and easy to misdiagnosis. In this paper,a 19-year-old woman,reviewed the relevant literature,summarized the findings,discussed the clinical characteristics,pathological histology,diagnosis,differential diagnosis,treatment and prognosis,so as to improve clinical and pathological awareness of the disease,and reduce misdiagnosis and mistreatment. gastroblastoma biphasic differentiation stomach neoplasm clinicopathologic feature Figures Figure 1 Figure 2 Figure 3 Figure 4 Case Report clinical features The 19-year-old female patient was admitted on August 12,2021 for “gastrointestinal stromal tumor found in another hospital physical examination for 3 days”. In the past half a year, poor appetite, weight loss of 6kg. Physical examination showed that a mass could be touched on the umbilical cord,about 10cm×10cm in size,hard quality, blurred edges,general activity,no tenderness or rebound pain in the whole abdomen. Laboratory tests showed no obvious abnormalities in routine blood routine,liver and kidney function,coagulation, pancreatic function and tumor markers,gastroduodenoscopy showed compression changes in the antrum. The abdominal CT showed the pancreatic head area, a clear boundary,unclear lesion and pancreatic head,obvious compression of the stomach and duodenum,and internal septation with multiple cysts.“Solid pancreatic pseudopiloma”was considered (Figure 1A). The abdominal MRI showed a solid mass in the pancreatic head with clear boundary, size of about 8.1cm×6.9cm×4.6cm,and necrosis and cystic changes. “Solid pancreatic pseudopiloma”was considered (Figure 1B). Clinical plan "pancreatic duodenal radical resection", intraoperative see tumor from gastric wall inflation,exogenous,root is located in the antrum,pylorus dorsal, to the pancreatic head compression,tumor boundary clear,complete capsule, and surrounding organs without infiltration,adhesion,abdominal enlargement,the pancreas,so changed to “partial gastrectomy + gastrojejunum Ronx-y anastomosis”. Pathological examination: Part of the gastric tissue submitted for inspection, a clear mass was seen on the serous surface of the stomach wall,the size was about 8.0cm ×6.9cm×4.5cm,the section of the mass was solid,the solid area was gray,white and red solid nature, and the area was necrosis and mucoid attachment. Microscopy: Under low magnification microscope, the tumor grew in the submucosa, muscle layer and serosa layer, locally infiltrating into the mucosal lamina propria, and parts of the tumor were separated into nodular and nested by smooth muscle bundles (Figure 2A). The tumor consisted of epithelium and mesenchyma, among which the mesenchyma accounted for about 90%. The epithelial components were scattered in foci and mixed with the interstitial lobe,but the boundary was still clear (Figure 2B). Epithelioid pattern,with mild cell morphology and fine nucleoli,mesenchyme is composed of sparse and dense areas,spindle tumor cells,with mild atypia,myoid degeneration in some stromal areas,and nuclear division <5 / 50 HPF. Immunophenotype: Epithelioid regional tumor cells expressed EMA,CKpan,CD10 and CD56 (Figure 3A),Mesenchymal tumor cells expressed vimentin,CD10 and CD56 (Figure 3B). Tumor cells in the epithelial and stromal regions DOG-1,CD34,S-100,SOX-10,STAT6,SMA,desmin,Syn,CgA were negative,SDHB positive expression, Ki-67 proliferation index was 3%. Molecular pathology: Fluorescence in situ hybridization (FISH) of tumor tissue showed no broken rearrangement of the GLI 1 gene (Figure 4A) or that of the EWSR 1 gene in the patient's tumor (Figure 4B). Pathological diagnosis: Combined with the histological morphology of the tumor components,immunohistochemical results and the opinions of several consultation units,all support the diagnosis of gastric blastoma (low-degree malignant). Follow-up: After partial gastrectomy, no special treatment,and no recurrence or metastasis after 19 months of follow-up. Discussion In 2009,Miettinen et al. first described a novel bidirectional differentiated gastric tumor in young adults,called“gastruloblastoma” (Gastroblastoma,GB) [1] .The pathogenesis of this tumor is still unclear,but some scholars believe that it was developed from a totipotent stem cell [2] .To date, a total of 17 cases were reported in the domestic and foreign literature [1,3-16] ,Among which,13 cases were reported in the English literature [1,2-12] ,4 cases were reported in the Chinese literature [13-16] ,The clinicopathological characteristics of the 17 gastric oblastomas are shown in Table 1. The WHO (2019) 5th edition of the digestive system tumor classification first included gastric blastoma,and placed under the malignant epithelial tumor category of the stomach, ICD-O code is 1,suggesting that it has low malignant potential [2] 。 Gastroblastoma occurs in young patients,occasionally in the elderly,the onset age is 9~79 years old,the average age is 35 years old,the proportion of male and female onset is close to 1:1. Gastrlastoma occurs in the antrum,followed by the greater curvature of the gastric body,with a maximum diameter of 1.3-15 cm and an average of 5.7 cm. In most of the reported cases,patients often have no obvious and specific clinical manifestations,and most of them are abdominal pain,abdominal space occupying,hematochezia, anemia and fatigue,or no obvious symptoms.This 19-year-old young female patient,with no obvious clinical symptoms,was initially diagnosed as “gastrointestinal stromal tumor” by physical examination and was admitted for CT and MRI,which showed a solid mass in the pancreatic head with clear boundary,necrosis and cystic changes, and “solid pancreatic pseudoppapilloma” was considered.“pancreaticoduodenal radical duodenectomy” was proposed. During the operation,the tumor was swollen from the posterior wall of the antrum,with exogenous type,the root was located in the dorsal side of the antrum and pylorus,and compressed to the pancreatic head, and no mass in the pancreas,so it was changed to “partial gastrectomy”. Gastroblastomas are generally exophytic growth,relatively large multinodular or lobulated,often solid,can also be cystic or ulcerated,the boundary is clear,the maximum diameter of the tumor is about 1.3~15.0 cm.Tumor section changes diversified,can be colorful,flower spot or mottled bleeding.Microscopically, the tumor showed infiltrative growth and could involve the whole layer of the gastric wall or be confined to the serosal layer. The tumor mainly consists of two components with different proportions of epithelioid cells and spindle cells. Epithelioid cells can be arranged in nest clumps, cables, tufts or ducts,in the lumen with or without eosrotropic secretion, with mild cell morphology and partial fine nucleoli. The dle cell area is bundle,sheet,can also be loose network,vortex,cell morphology is more consistent, oval or short spindle, less cytoplasm, cell nucleus has no obvious atypia. Stroma can be accompanied by sclerosis or myxoid degeneration, and some cases show pulmonary edema-like structure,multinucleated giant cells,erythrocyte extravasation,occasional necrosis and calcification [8-9] . Although the epithelial and mesoee components often exist,the boundary between the two components is still clear. Nuclear otic images are rare,mostly 0-5 / 50 HPF,only one case up to 30/50 HPF. In this case,the main body of the tumor was located in the submucosa,muscle layer and serosa layer,locally invaded the mucosal lamina propria, and partially separated by smooth muscle bundles,with nodular,mild cell shape, mostly spindle, epithelioid, fine nucleoli,rare nucleotic images,and interstitial myxoid degeneration in some areas. Immunohistochemical staining showed that epithelial regional tumor cells CK (AE1/AE3),CK7,CAM 5.2,and EMA were all positive, expressing CD56 and CD10 to varying degrees,some cases expressed CK8 and CK18,but CK20 was usually negative,mesenchymal regional tumor cells were positive for Vimentin,CD56,and CD10,expressing CD99 to varying degrees. In some cases,desmin was patchy positive in stromal area or CD117 positive in epithelial area, and Ki-67 proliferative index was low (<5%). Tumor cells in the epithelial and mesenchymal regions were negative for DOG-1, CD34, S-100, SOX-10, STAT6, SMA, C-Kit, Calretinin, Syn, CgA, TTF-1, ER,and PR. The immunohistochemical results of this case are consistent with the reported gastruloblastoma. In terms of cellular and molecular genetics,six of the reported cases of confirmed MALAT1-GLI 1 fusion gene [5,15,17] ,Graham class [17] For the first time in four cases of gastroblastoma by reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence in situ hybridization (FISH) at the transcriptional and genomic level, respectively, the immunohistochemistry of gastroblastoma showed GLI1 overexpression, diffuse strong positive expression of the nucleus and cytoplasm of epithelial and mesoplastic components,thus further provide reliable support for the diagnosis of gastroblastoma. Meanwhile,the fusion of the MALAT1-GLI 1 gene,which indicates the activation of the Sonic hedgehog pathway in gastroblastoma,is thus expected to provide precise targeted therapy for patients with locally advanced or metastatic tumors. However, it should not be ignored that for another recently reported rare gastric tumor, plexiform fibromyxoma,MALAT1-GLI1 fusion gene and GLI1 protein were also detected in some cases of this tumor,and the structure of the fusion gene was consistent with that of gastroblastoma [18] . However,the histological features of plexiform fibromyxoma lack biphasic differentiation,which can facilitate the differentiation. In addition,the KOO et al [12] In 2021,a gastric submucosal tumor developed in a 17-year-old young man with Wiskott-Aldrich syndrome and a history of multiple allogeneic bone marrow transplantation and radiotherapy was reported. The histological morphology of tumor components and immunohistochemical results supported the diagnosis of gastrroblastoma. However,genetic tests showed that no MALAT1-GLI 1 fusion gene was found in the tumor of this patient,instead,comprehensive molecular analysis revealed a new EWSR1-CTBP1 fusion gene,with no specific changes in other genes. In this case,a 19-year-old young woman supported the diagnosis of gastroblastoma based on the histological morphology,IHC results and the opinions of several consultation units. However,FISH results showed that the broken rearrangement of GLI1 gene and EWSR1 gene were not found in the tumor of this patient. Therefore, in view of the limited number of cases reported in gastroblastoma at home and abroad, there is still a lack of sufficient understanding of the nature of the disease and the exact gene mutation,that is,the mechanism of the development of the disease still needs more cases and data accumulation. Because its histological morphology is bidirectional differentiation of epithelium and interstitial lobe,gastric blastoma should be differentiated from the following diseases at diagnosis: (1) carcinosarcoma: highly malignant and high-grade,and the epithelial components are squamous,adenoid and other arrangement ways.(2) Synovial sarcoma: rare in the stomach,mostly nodular or lobulated,cytogenetically specific t (X,18) (p11,q11),and produce SS18 (SYT) -SSX fusion gene, (3) Teratoma: relatively diverse tumor components, tissues with three germ layers, such as body cavity epithelium,neuroepithelium and cartilage components.(4) Gastrointestinal stromal tumor (GIST): mainly spindle or epithelioid cells without epithelial cell differentiation, were positive for DOG1, CD34 and CD117,and SDHB expression was positive in this case, so SDHB-deficient GIST was excluded. In addition, PDGFR and c-kit gene mutations are often present in GIST.(5) Neuroendocrine tumors: often with organoid structures,positive for Syn and CgA.(6) Angiotumor: tumor cells grew sheets or sheets around the vessels, both positive for SMA and vimentin, special PAS staining showed positive luminal eosin secretion.(7)Pleexiform fibromyxoma: tumors has MALAT1-GLI1 fusion gene,but histological features lack biphasic differentiation. Gastroblastoma is a low-grade malignancy, and its biological behavior is not clear. Among the 17 cases reported so far,most of their biological behavior are indolent,and they usually avoid recurrence and metastasis after complete surgical resection,with a good prognosis. However, three cases of regional lymph nodes and distant liver and retroperitoneal metastasis have been reported,one of which died after 7 months of follow-up [6,10,17] . In this case,the gastric space was found by physical examination, and the tumor was followed for 19 months after complete resection, with no tumor recurrence or metastasis. In conclusion,gastroblastoma is a recently discovered gastric tumor with epithelial and interlobe bipolar differentiation. Due to the small number of cases reported in the domestic and foreign literature,the lack of sufficient understanding of the nature of this disease,and its biological behavior is unclear. At present, most of the cases in follow-up are relatively indolent clinical procedures,and complete surgical resection often presents with disease-free survival and a relatively good prognosis,but there is also a risk of lymph nodes and distant metastasis. Therefore,it is hoped that more cases can be found,which is expected to help medical workers deepen their understanding of the disease and avoid missed diagnosis and misdiagnosis. Abbreviations GB Gastroblastoma FISH fluorescence in situ hybridization IHC Immunohistochemical method GIST Gastrointestinal stromal tumor CT Computed tomography MRI Magnetic resonance imaging Declarations Acknowledgements The authors would like to express their appreciation to Dr. Yimin,chief of the Department of Pathology of Liuzhou Workers' Hospital, she suggested about the diagnosis of gastroblastoma. AND appreciation to Professor Mao Rong jun, Department of Pathology, Foshan Hospital of traditional Chinese Medicine for providing FISH technology for the detection of MALAT1 and GLI1 genes. Authors’ contributions Gong can, Qiao Shu ye and Yi Min designed and supervised research. Gong can and Xu Jun yi wrote the main manuscript text and table1. Qiao Shu ye and Zhang Xue mei prepared figures 1-4.All authors interpreted the data and contributed to the final version of the manuscript. Funding There is financial support related to the project of Liuzhou Science and Technology Bureau. Availability of data and materials Not applicable. Ethics approval and consent to participate Not applicable. Consent for publication Informed consent was obtained from the patient to report the case. Competing interests The authors declare no competing interests. Author details 1 Gong can, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China. 2 Xu Jun yi, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China. 1 Qiao Shu ye, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China. 1 Zhang Xue mei, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China. * Yimin, director of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China. References M.Miettinen, N.Dow, J.Lasota, and L.H Sobin, “ A distinctive novel epitheliomesenchymal biphasic tumor of the stomach in young adults (‘gastroblastoma’): a series of 3 cases, ” The American Journal of Surgical Pathology, vol.33, pp.1370–1377, 2009. Agha R A, Fowler A J, Saeta A, et al.The SCARE statement: consensus-based surgical case report guidelines[J].International journal of surgery, 2016, 34: 180-186. D.Nogueira Pinto and A.Midões, “Gastroblastoma described in adult patient, ” International Journal of Case Reports and Images, vol.10, no.1, 2019. Centonze G, Mangogna A, Salviato T, et al.Gastroblastoma in Adulthood—A Rarity among Rare Cancers—A Case Report and Review of the Literature[J].Case reports in pathology, 2019, 2019: 4084196. Castri F, Ravegnini G, Lodoli C, et al.Gastroblastoma in old age[J].Histopathology ,2019,75: 778-782. O.Toumi, H.Ammar, I.Korbi et al.“Gastroblastoma, a biphasic neoplasm of stomach: a case report, ” International Journal of Surgery Case Reports, vol.39, pp.72–76, 2017. N.Zheng, X.M.Xiao, K.R.Dong, L.Chen, Y .Y .Ma, and K.Li, “Primary gastric tumors in infants and children: 15 cases of 20-year report, ” Journal of Cancer Research and Clinical Oncology, vol.142, no.5, pp.1061–1067, 2016. Y .Ma, J.Zheng, H.Zhu et al., “Gastroblastoma in a 12-year-old Chinese boy, ” International Journal Clinical and Experimental Pathology, vol.7, no.6, pp.3380–3384, 2014. T.R.Fernandes, V .Silva, J.M.Devesa, F .Lopes, and B.Carneiro, “Viamonte, AIRP Best Cases in Radiologic-Pathologic Correlation: Gastroblastoma: a Rare Biphasic Gastric Tumor, ” RadioGraphics, vol.34, no.7, pp.1929–1933, 2014. E.A.Wey, A.J.Britton, J.J.Sferra, T.Kasunic, L.R.Pepe, and H.D.Appelman, “Gastroblastoma in a 28-year-old man with nodal metastasis: Proof of the malignant potential, ” Archives of Pathology & Laboratory Medicine, vol.136, pp.961–964, 2012. D.H.Shin, J.H.Lee, H.J.Kang et al., “Novel epitheliomesenchymal biphasic stomach tumour (gastroblastoma) in a 9-year-old: Morphological, usltrastructural and immunohistochemical findings,” Journal of Clinical Pathology, vol.63, no.3, pp.270–274, 2010. Koo S C, LaHaye S, Kovari B P, et al.Gastroblastoma with a novel EWSR1‐CTBP1 fusion presenting in adolescence[J].Genes, Chromosomes and Cancer, 2021, 60(9): 640-646. Zhu Na, Hou Valve, Ge Xiaowen, et al. A small volume gastrroblastoma occurred in a 65-year-old woman [J]. Journal of Diagnosis Pathology, 2018,25 (4). Long Weiguo, Zhuang Ying, Li Mei, Zheng Fang, Zhong Anjing, Wang Deqiang, Wu Jiannong. A case of gastruloblastoma [J]. Chinese Journal of Pathology, 2020,49 (07): 761-763. Chen Simin, Zhang Yifen, Sun Yi, Li Hui, Kefei, Wang Lu, Xie Ling. Clinicopathological observation and review of literature [J]. Journal of Diagnostic Pathology, 2022,29 (09): 858-860. Chen Qi, Zhang Yanyan, Li Yulian, Wu Liang, Li Jianmin, Chen Guorong. Gastroblastoma in 1 case [J].Journal of Clinical and Experimental pathology, 2022,38(09):1151-1152. DOI:10.13315/j. cnki.cjcep. 2022.09.033. Graham R P, Nair A A, Davila J I, et al.Gastroblastoma harbors a recurrent somatic MALAT1–GLI1 fusion gene[J].Modern Pathology, 2017, 30(10): 1443-1452. Spans L, Fletcher C D M, Antonescu C R, et al.Recurrent MALAT1–GLI1 oncogenic fusion and GLI1 up‐regulation define a subset of plexiform fibromyxoma[J].The Journal of pathology, 2016, 239(3): 335-343. Table 1 Clinicopathological characteristics of 17 gastrooblastomas reported in Table 1 author age (year) sex clinlcal symptom position Tumor size(cm) treat Follow up Miettnen et al [1] 30 man Anti-force, anemia sinuses ventriculi 15×12 Gastrosinus resection+ postoperative radiotherapy For 14 years, with disease-free survival Miettnen et al [1] 27 woman Abdominal pain, and an abdominal mass Large curved stomach 6×4×3.5 Partial gastrectomy 5 years:disease-free survival Miettnen et al [1] 19 man Abdominal pain, and an abdominal mass Large curved stomach 5×4×2.5 The stomach was excised in large parts At 3.5 years, with disease-free survival Pinto et al [3] 53 woman indigestion Large curved stomach sinus 2.3 Partial gastrectomy 1.5 years, disease-free survival Centonze et al [4] 43 woman enterorrhagid sinuses ventriculi 5.3 Partial gastrectomy And 8.4 years, with disease-free survival Castri F et al [5] 79 man abdominal mass sinuses ventriculi 3 Partial gastrectomy not clear Toumi et al [6] 29 woman Upper abdominal pain, vomiting blood Large curved stomach 7 Partial gastrectomy + splenectomy Local recurrence in situ after 6 months Na Zheng et al [7] 12 man bloody stool not clear 7 Subtotal gastric resection For 8 months, with disease-free survival Yangyang Ma et al [8] 12 man Hemochezia, and abdominal mass sinuses ventriculi 4.5×2.5×2.5 The stomach was excised in large parts For 8 months, with disease-free survival Teresa Femand-ez et al [9] 19 woman Abdominal pain, radiating to the back, abdominal mass sinuses ventriculi 10.5 A distal gastrectomy was performed At 20 months, with disease-free survival Wey et al [10] 28 man Constipation, and an abdominal mass Far stomach 3.8×3.3×2.5 Preoperative chemotherapy + partial gastrectomy Liver, lymph node, retroperitoneal and bladder metastases , Three months after surgery, the clinical condition is good Shin et al [11] 9 man Abdominal pain, and an abdominal mass Gastric bin 9×6.5 Pargastric antrum + pylorus removed At 9 months, with disease-free survival Koo et al [12] 17 man Wiskott-Aldrich syndrome fundus ventriculi 6.3 Partial gastrectomy 23 months: disease-free survival Zhu na et al [13] 65 woman Physical examination of gastric space Large curved stomach body 1.3×1×0.9 Full-thickness resection of the gastric wall (EPTR) For 4 years, with disease-free survival Long Wei guo et al [14] 53 woman The upper abdomen is dull and painful The junction of gastric antrum and gastric body 5.0×4.2×4.0 Partial gastrectomy At 14 months, with disease-free survival Chen Si min et al [15] 51 woman Black stool, dizziness, black dark sinuses ventriculi 2.8×1.8×1.5 Partial gastrectomy At 9 months, with disease-free survival Chen Qi et al [16] 43 man Reverse the acid and make a black stool sinuses ventriculi 5.5×5.3 Partial gastrectomy 2 years: disease-free survival Our case 19 woman Loss of appetite, and lost body weight sinuses ventriculi 8.1×6.9×4.6 Partial gastrectomy At 19 months, with disease-free survival Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Sep, 2023 Read the published version in World Journal of Surgical Oncology → Version 1 posted Editorial decision: Major revision 25 May, 2023 Reviews received at journal 17 May, 2023 Reviews received at journal 14 May, 2023 Reviewers agreed at journal 09 May, 2023 Reviewers agreed at journal 05 May, 2023 Reviewers agreed at journal 12 Apr, 2023 Reviewers invited by journal 06 Apr, 2023 Editor assigned by journal 29 Mar, 2023 Submission checks completed at journal 29 Mar, 2023 First submitted to journal 26 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2739475","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":187660991,"identity":"d6ec6751-475f-4221-b56b-0a0d103ce369","order_by":0,"name":"Can Gong","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Can","middleName":"","lastName":"Gong","suffix":""},{"id":187660992,"identity":"31cf0198-8c34-4d7a-b434-f574cf44fc6d","order_by":1,"name":"Jun yi Xu","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jun","middleName":"yi","lastName":"Xu","suffix":""},{"id":187660993,"identity":"33377eb9-4522-4d71-a081-829bb304d1c8","order_by":2,"name":"Shu ye Qiao","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shu","middleName":"ye","lastName":"Qiao","suffix":""},{"id":187660994,"identity":"640f9e12-a8d5-4d3b-832f-4333d6c794d6","order_by":3,"name":"Xue mei Zhang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xue","middleName":"mei","lastName":"Zhang","suffix":""},{"id":187660995,"identity":"345b09d6-2f73-4056-bc7c-26b6f88d4944","order_by":4,"name":"Min Yi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYDCCA8yNBxj/2fCwMTM2PkiosCFGC2PDAQa2NBk+duZmgwdn0ojWcthGjp+9TfJh2yHCOviONzYc5uE5DHJYW0UC2wEG/vbuBLxaJM8cBGqRSAdruZHAc4dB4szZDXi1GNxIBGoxsIZqkXjGYCCRS4yWBGawloIEg8PEajngDNbCkJBAhBaQXw7ObUgDaWmWSDiQxkPQL3zHmw8+eNtgYy/ff/zhx5//gIHd3otfCwgw8SBxeHAqQwaMP4hSNgpGwSgYBSMWAADqk0zY3qd9xAAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Yi","suffix":""}],"badges":[],"createdAt":"2023-03-27 00:59:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2739475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2739475/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12957-023-03159-7","type":"published","date":"2023-09-01T15:09:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":35124717,"identity":"8cb135e6-8a54-4124-a4fb-40ab831fcf77","added_by":"auto","created_at":"2023-03-31 21:38:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":329811,"visible":true,"origin":"","legend":"\u003cp\u003eImaging examination 1A:Abdominal CT shows a mass in the pancreatic head area,the boundary was clear,and the boundary between the lesion and the pancreatic head was not clear;1B:Abdominal MRI showed a solid mass in the pancreatic head, with clear boundary,and internal necrosis and sac.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2739475/v1/0925587ac9a331421456284c.png"},{"id":35124720,"identity":"76ea8651-5af6-44ea-ae8b-109501f6a31d","added_by":"auto","created_at":"2023-03-31 21:38:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":718149,"visible":true,"origin":"","legend":"\u003cp\u003eHistological morphology of gastroblastoma 2A: Tumor cells grow in the mucosa, submucosa and muscularis propria,and some areas are separated into nodulules and nests by smooth muscle bundles;2B: Tumor is composed of epithelium and mesoyes,which are intermixed,but the boundaries are relatively well-defined.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2739475/v1/4cac40ae0cd17b9dd1fae21a.png"},{"id":35125763,"identity":"b3d4e048-9ca9-43e4-8b8d-4aab07df5f38","added_by":"auto","created_at":"2023-03-31 21:46:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":764376,"visible":true,"origin":"","legend":"\u003cp\u003eImmunohistochemistry in gastroblastoma 3A:EMA was strongly positive in the epithelial area and negative in the surrounding mesenchymal component; 3B:CD56 was strongly positive in the mesenchymal component and epithelial area.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2739475/v1/417a97ea1ffb3db118575359.png"},{"id":35124718,"identity":"ac3b8169-29cb-4b1e-8178-9a67e6009ecc","added_by":"auto","created_at":"2023-03-31 21:38:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":373088,"visible":true,"origin":"","legend":"\u003cp\u003eFluorescence in situ hybridization (FISH) in gastroblastoma 4A:No GLI1 gene break rearrangement was detected; 4B:No EWSR1 gene break rearrangement was detected.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-2739475/v1/0212f758e3ad828fc64199df.png"},{"id":42781933,"identity":"0f792238-b0c0-408a-8690-6bfc9dfd22e8","added_by":"auto","created_at":"2023-09-07 15:15:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2173245,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2739475/v1/0fb927dd-fc0b-4af7-9d7f-98bde942788c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gastroblastoma without GLI1 and EWSR1 gene breaks","fulltext":[{"header":"Case Report","content":"\u003cp\u003e\u003cstrong\u003eclinical features\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 19-year-old female patient was admitted on August 12,2021 for \u0026ldquo;gastrointestinal stromal tumor found in another hospital physical examination for 3 days\u0026rdquo;.\u0026nbsp;In the past half a year, poor appetite, weight loss of 6kg. Physical examination showed that a mass could be touched on the umbilical cord,about 10cm\u0026times;10cm in size,hard quality, blurred edges,general activity,no tenderness or rebound pain in the whole abdomen. Laboratory tests showed no obvious abnormalities in routine blood routine,liver and kidney function,coagulation, pancreatic function and tumor markers,gastroduodenoscopy showed compression changes in the antrum. The abdominal CT showed the pancreatic head area, a clear boundary,unclear lesion and pancreatic head,obvious compression of the stomach and duodenum,and internal septation with multiple cysts.\u0026ldquo;Solid pancreatic pseudopiloma\u0026rdquo;was considered (Figure 1A). The abdominal MRI showed a solid mass in the pancreatic head with clear boundary, size of about 8.1cm\u0026times;6.9cm\u0026times;4.6cm,and necrosis and cystic changes.\u0026nbsp;\u0026ldquo;Solid pancreatic pseudopiloma\u0026rdquo;was considered (Figure 1B). Clinical plan \u0026quot;pancreatic duodenal radical resection\u0026quot;, intraoperative see tumor from gastric wall inflation,exogenous,root is located in the antrum,pylorus dorsal, to the pancreatic head compression,tumor boundary clear,complete capsule, and surrounding organs without infiltration,adhesion,abdominal enlargement,the pancreas,so changed to\u0026nbsp;\u0026ldquo;partial gastrectomy + gastrojejunum Ronx-y anastomosis\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathological examination:\u003c/strong\u003ePart of the gastric tissue submitted for inspection, a clear mass was seen on the serous surface of the stomach wall,the size was about 8.0cm \u0026times;6.9cm\u0026times;4.5cm,the section of the mass was solid,the solid area was gray,white and red solid nature, and the area was necrosis and mucoid attachment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicroscopy:\u003c/strong\u003e Under low magnification microscope, the tumor grew in the submucosa, muscle layer and serosa layer, locally infiltrating into the mucosal lamina propria, and parts of the tumor were separated into nodular and nested by smooth muscle bundles (Figure 2A). The tumor consisted of epithelium and mesenchyma, among which the mesenchyma accounted for about 90%. The epithelial components were scattered in foci and mixed with the interstitial lobe,but the boundary was still clear (Figure 2B). Epithelioid pattern,with mild cell morphology and fine nucleoli,mesenchyme is composed of sparse and dense areas,spindle tumor cells,with mild atypia,myoid degeneration in some stromal areas,and nuclear division \u0026lt;5 / 50 HPF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImmunophenotype:\u003c/strong\u003e Epithelioid regional tumor cells expressed EMA,CKpan,CD10 and CD56 (Figure 3A),Mesenchymal tumor cells expressed vimentin,CD10 and CD56 (Figure 3B).\u0026nbsp;Tumor cells in the epithelial and stromal regions DOG-1,CD34,S-100,SOX-10,STAT6,SMA,desmin,Syn,CgA were negative,SDHB positive expression, Ki-67 proliferation index was 3%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMolecular pathology:\u003c/strong\u003eFluorescence in situ hybridization (FISH) of tumor tissue showed no broken rearrangement of the GLI 1 gene (Figure 4A) or that of the EWSR 1 gene in the patient\u0026apos;s tumor (Figure 4B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathological diagnosis:\u003c/strong\u003e Combined with the histological morphology of the tumor components,immunohistochemical results and the opinions of several consultation units,all support the diagnosis of gastric blastoma (low-degree malignant).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up:\u003c/strong\u003e After partial gastrectomy, no special treatment,and no recurrence or metastasis after 19 months of follow-up.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn 2009,Miettinen et al. first described a novel bidirectional differentiated gastric tumor in young adults,called\u0026ldquo;gastruloblastoma\u0026rdquo; (Gastroblastoma,GB)\u003csup\u003e[1]\u003c/sup\u003e.The pathogenesis of this tumor is still unclear,but some scholars believe that it was developed from a totipotent stem cell\u003csup\u003e[2]\u003c/sup\u003e.To date, a total of 17 cases were reported in the domestic and foreign literature\u003csup\u003e[1,3-16]\u003c/sup\u003e,Among which,13 cases were reported in the English literature\u003csup\u003e[1,2-12]\u003c/sup\u003e,4 cases were reported in the Chinese literature\u003csup\u003e[13-16]\u003c/sup\u003e,The clinicopathological characteristics of the 17 gastric oblastomas are shown in Table 1.\u0026nbsp;The WHO (2019) 5th edition of the digestive system tumor classification first included gastric blastoma,and placed under the malignant epithelial tumor category of the stomach, ICD-O code is 1,suggesting that it has low malignant potential\u003csup\u003e[2]\u003c/sup\u003e。\u003c/p\u003e\n\u003cp\u003eGastroblastoma occurs in young patients,occasionally in the elderly,the onset age is 9~79 years old,the average age is 35 years old,the proportion of male and female onset is close to 1:1. Gastrlastoma occurs in the antrum,followed by the greater curvature of the gastric body,with a maximum diameter of 1.3-15 cm and an average of 5.7 cm. In most of the reported cases,patients often have no obvious and specific clinical manifestations,and most of them are abdominal pain,abdominal space occupying,hematochezia, anemia and fatigue,or no obvious symptoms.This 19-year-old young female patient,with no obvious clinical symptoms,was initially diagnosed as \u0026ldquo;gastrointestinal stromal tumor\u0026rdquo; by physical examination and was admitted for CT and MRI,which showed a solid mass in the pancreatic head with clear boundary,necrosis and cystic changes, and \u0026ldquo;solid pancreatic pseudoppapilloma\u0026rdquo; was considered.\u0026ldquo;pancreaticoduodenal radical duodenectomy\u0026rdquo; was proposed. During the operation,the tumor was swollen from the posterior wall of the antrum,with exogenous type,the root was located in the dorsal side of the antrum and pylorus,and compressed to the pancreatic head, and no mass in the pancreas,so it was changed to \u0026ldquo;partial gastrectomy\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eGastroblastomas are generally exophytic growth,relatively large multinodular or lobulated,often solid,can also be cystic or ulcerated,the boundary is clear,the maximum diameter of the tumor is about 1.3~15.0 cm.Tumor section changes diversified,can be colorful,flower spot or mottled bleeding.Microscopically, the tumor showed infiltrative growth and could involve the whole layer of the gastric wall or be confined to the serosal layer. The tumor mainly consists of two components with different proportions of epithelioid cells and spindle cells. Epithelioid cells can be arranged in nest clumps, cables, tufts or ducts,in the lumen with or without eosrotropic secretion, with mild cell morphology and partial fine nucleoli. The dle cell area is bundle,sheet,can also be loose network,vortex,cell morphology is more consistent, oval or short spindle, less cytoplasm, cell nucleus has no obvious atypia. Stroma can be accompanied by sclerosis or myxoid degeneration, and some cases show pulmonary edema-like structure,multinucleated giant cells,erythrocyte extravasation,occasional necrosis and calcification\u003csup\u003e[8-9]\u003c/sup\u003e. Although the epithelial and mesoee components often exist,the boundary between the two components is still clear. Nuclear otic images are rare,mostly 0-5 / 50 HPF,only one case up to 30/50 HPF. In this case,the main body of the tumor was located in the submucosa,muscle layer and serosa layer,locally invaded the mucosal lamina propria, and partially separated by smooth muscle bundles,with nodular,mild cell shape, mostly spindle, epithelioid, fine nucleoli,rare nucleotic images,and interstitial myxoid degeneration in some areas.\u003c/p\u003e\n\u003cp\u003eImmunohistochemical staining showed that epithelial regional tumor cells CK (AE1/AE3),CK7,CAM 5.2,and EMA were all positive, expressing CD56 and CD10 to varying degrees,some cases expressed CK8 and CK18,but CK20 was usually negative,mesenchymal regional tumor cells were positive for Vimentin,CD56,and CD10,expressing CD99 to varying degrees. In some cases,desmin was patchy positive in stromal area or CD117 positive in epithelial area, and Ki-67 proliferative index was low (\u0026lt;5%). Tumor cells in the epithelial and mesenchymal regions were negative for DOG-1, CD34, S-100, SOX-10, STAT6, SMA, C-Kit, Calretinin, Syn, CgA, TTF-1, ER,and PR. The immunohistochemical results of this case are consistent with the reported gastruloblastoma. In terms of cellular and molecular genetics,six of the reported cases of confirmed MALAT1-GLI 1 fusion gene\u003csup\u003e[5,15,17]\u003c/sup\u003e,Graham class\u003csup\u003e[17]\u003c/sup\u003eFor the first time in four cases of gastroblastoma by reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence in situ hybridization (FISH) at the transcriptional and genomic level, respectively, the immunohistochemistry of gastroblastoma showed GLI1 overexpression, diffuse strong positive expression of the nucleus and cytoplasm of epithelial and mesoplastic components,thus further provide reliable support for the diagnosis of gastroblastoma. Meanwhile,the fusion of the MALAT1-GLI 1 gene,which indicates the activation of the Sonic hedgehog pathway in gastroblastoma,is thus expected to provide precise targeted therapy for patients with locally advanced or metastatic tumors. However, it should not be ignored that for another recently reported rare gastric tumor, plexiform fibromyxoma,MALAT1-GLI1 fusion gene and GLI1 protein were also detected in some cases of this tumor,and the structure of the fusion gene was consistent with that of gastroblastoma\u003csup\u003e[18]\u003c/sup\u003e. However,the histological features of plexiform fibromyxoma lack biphasic differentiation,which can facilitate the differentiation. In addition,the KOO et al\u003csup\u003e[12]\u003c/sup\u003eIn 2021,a gastric submucosal tumor developed in a 17-year-old young man with Wiskott-Aldrich syndrome and a history of multiple allogeneic bone marrow transplantation and radiotherapy was reported. The histological morphology of tumor components and immunohistochemical results supported the diagnosis of gastrroblastoma. However,genetic tests showed that no MALAT1-GLI 1 fusion gene was found in the tumor of this patient,instead,comprehensive molecular analysis revealed a new EWSR1-CTBP1 fusion gene,with no specific changes in other genes. In this case,a 19-year-old young woman supported the diagnosis of gastroblastoma based on the histological morphology,IHC results and the opinions of several consultation units. However,FISH results showed that the broken rearrangement of GLI1 gene and EWSR1 gene were not found in the tumor of this patient. Therefore, in view of the limited number of cases reported in gastroblastoma at home and abroad, there is still a lack of sufficient understanding of the nature of the disease and the exact gene mutation,that is,the mechanism of the development of the disease still needs more cases and data accumulation.\u003c/p\u003e\n\u003cp\u003eBecause its histological morphology is bidirectional differentiation of epithelium and interstitial lobe,gastric blastoma should be differentiated from the following diseases at diagnosis: (1) carcinosarcoma: highly malignant and high-grade,and the epithelial components are squamous,adenoid and other arrangement ways.(2) Synovial sarcoma: rare in the stomach,mostly nodular or lobulated,cytogenetically specific t (X,18) (p11,q11),and produce SS18 (SYT) -SSX fusion gene, (3) Teratoma: relatively diverse tumor components, tissues with three germ layers, such as body cavity epithelium,neuroepithelium and cartilage components.(4) Gastrointestinal stromal tumor (GIST): mainly spindle or epithelioid cells without epithelial cell differentiation, were positive for DOG1, CD34 and CD117,and SDHB expression was positive in this case, so SDHB-deficient GIST was excluded. In addition, PDGFR and c-kit gene mutations are often present in GIST.(5) Neuroendocrine tumors: often with organoid structures,positive for Syn and CgA.(6) Angiotumor: tumor cells grew sheets or sheets around the vessels, both positive for SMA and vimentin, special PAS staining showed positive luminal eosin secretion.(7)Pleexiform fibromyxoma: tumors has MALAT1-GLI1 fusion gene,but histological features lack biphasic differentiation.\u003c/p\u003e\n\u003cp\u003eGastroblastoma is a low-grade malignancy, and its biological behavior is not clear. Among the 17 cases reported so far,most of their biological behavior are indolent,and they usually avoid recurrence and metastasis after complete surgical resection,with a good prognosis. However, three cases of regional lymph nodes and distant liver and retroperitoneal metastasis have been reported,one of which died after 7 months of follow-up\u003csup\u003e[6,10,17]\u003c/sup\u003e. In this case,the gastric space was found by physical examination, and the tumor was followed for 19 months after complete resection, with no tumor recurrence or metastasis.\u003c/p\u003e\n\u003cp\u003eIn conclusion,gastroblastoma is a recently discovered gastric tumor with epithelial and interlobe bipolar differentiation. Due to the small number of cases reported in the domestic and foreign literature,the lack of sufficient understanding of the nature of this disease,and its biological behavior is unclear. At present, most of the cases in follow-up are relatively indolent clinical procedures,and complete surgical resection often presents with disease-free survival and a relatively good prognosis,but there is also a risk of lymph nodes and distant metastasis. Therefore,it is hoped that more cases can be found,which is expected to help medical workers deepen their understanding of the disease and avoid missed diagnosis and misdiagnosis.\u003c/p\u003e"},{"header":"Abbreviations ","content":"\u003cp\u003eGB \u0026nbsp;Gastroblastoma\u003c/p\u003e\n\u003cp\u003eFISH \u0026nbsp;fluorescence in situ hybridization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIHC \u0026nbsp;Immunohistochemical method\u003c/p\u003e\n\u003cp\u003eGIST \u0026nbsp;Gastrointestinal stromal tumor\u003c/p\u003e\n\u003cp\u003eCT\u0026nbsp;\u0026nbsp;Computed tomography\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp;Magnetic resonance imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their appreciation to Dr. Yimin,chief of the Department of Pathology of Liuzhou Workers\u0026apos; Hospital, she suggested about the diagnosis of gastroblastoma. AND appreciation to Professor Mao Rong jun, Department of Pathology, Foshan Hospital of traditional Chinese Medicine for providing FISH technology for the detection of MALAT1 and GLI1 genes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGong can, Qiao Shu ye and Yi Min designed and supervised research. Gong can and Xu Jun yi wrote the main manuscript text and table1. Qiao Shu ye and Zhang Xue mei prepared figures 1-4.All authors interpreted the data and contributed to the final version of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is financial support related to the project of Liuzhou Science and Technology Bureau.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patient to report the case.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eGong can, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China.\u003csup\u003e2\u003c/sup\u003eXu Jun yi, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China.\u003csup\u003e1\u003c/sup\u003eQiao Shu ye, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China.\u003csup\u003e1\u003c/sup\u003eZhang Xue mei, department of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China.\u003csup\u003e*\u003c/sup\u003eYimin, director of Clinical Pathology, Liuzhou Workers Hospital, Guangxi, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eM.Miettinen, N.Dow, J.Lasota, and L.H Sobin, \u0026ldquo; A distinctive novel epitheliomesenchymal biphasic tumor of the stomach in young adults (\u0026lsquo;gastroblastoma\u0026rsquo;): a series of 3 cases, \u0026rdquo; The American Journal of Surgical Pathology, vol.33, pp.1370\u0026ndash;1377, 2009.\u003c/li\u003e\n\u003cli\u003eAgha R A, Fowler A J, Saeta A, et al.The SCARE statement: consensus-based surgical case report guidelines[J].International journal of surgery, 2016, 34: 180-186.\u003c/li\u003e\n\u003cli\u003eD.Nogueira Pinto and A.Mid\u0026otilde;es, \u0026ldquo;Gastroblastoma described in adult patient, \u0026rdquo; International Journal of Case Reports and Images, vol.10, no.1, 2019.\u003c/li\u003e\n\u003cli\u003eCentonze G, Mangogna A, Salviato T, et al.Gastroblastoma in Adulthood\u0026mdash;A Rarity among Rare Cancers\u0026mdash;A Case Report and Review of the Literature[J].Case reports in pathology, 2019, 2019: 4084196.\u003c/li\u003e\n\u003cli\u003eCastri F, Ravegnini G, Lodoli C, et al.Gastroblastoma in old age[J].Histopathology ,2019,75: 778-782.\u003c/li\u003e\n\u003cli\u003eO.Toumi, H.Ammar, I.Korbi et al.\u0026ldquo;Gastroblastoma, a biphasic neoplasm of stomach: a case report, \u0026rdquo; International Journal of Surgery Case Reports, vol.39, pp.72\u0026ndash;76, 2017.\u003c/li\u003e\n\u003cli\u003eN.Zheng, X.M.Xiao, K.R.Dong, L.Chen, Y .Y .Ma, and K.Li, \u0026ldquo;Primary gastric tumors in infants and children: 15 cases of 20-year report, \u0026rdquo; Journal of Cancer Research and Clinical Oncology, vol.142, no.5, pp.1061\u0026ndash;1067, 2016.\u003c/li\u003e\n\u003cli\u003eY .Ma, J.Zheng, H.Zhu et al., \u0026ldquo;Gastroblastoma in a 12-year-old Chinese boy, \u0026rdquo; International Journal Clinical and Experimental Pathology, vol.7, no.6, pp.3380\u0026ndash;3384, 2014.\u003c/li\u003e\n\u003cli\u003eT.R.Fernandes, V .Silva, J.M.Devesa, F .Lopes, and B.Carneiro, \u0026ldquo;Viamonte, AIRP Best Cases in Radiologic-Pathologic Correlation: Gastroblastoma: a Rare Biphasic Gastric Tumor, \u0026rdquo; RadioGraphics, vol.34, no.7, pp.1929\u0026ndash;1933, 2014.\u003c/li\u003e\n\u003cli\u003eE.A.Wey, A.J.Britton, J.J.Sferra, T.Kasunic, L.R.Pepe, and H.D.Appelman, \u0026ldquo;Gastroblastoma in a 28-year-old man with nodal metastasis: Proof of the malignant potential, \u0026rdquo; Archives of Pathology \u0026amp; Laboratory Medicine, vol.136, pp.961\u0026ndash;964, 2012.\u003c/li\u003e\n\u003cli\u003eD.H.Shin, J.H.Lee, H.J.Kang et al., \u0026ldquo;Novel epitheliomesenchymal biphasic stomach tumour (gastroblastoma) in a 9-year-old: Morphological, usltrastructural and immunohistochemical findings,\u0026rdquo; Journal of Clinical Pathology, vol.63, no.3, pp.270\u0026ndash;274, 2010.\u003c/li\u003e\n\u003cli\u003eKoo S C, LaHaye S, Kovari B P, et al.Gastroblastoma with a novel EWSR1‐CTBP1 fusion presenting in adolescence[J].Genes, Chromosomes and Cancer, 2021, 60(9): 640-646.\u003c/li\u003e\n\u003cli\u003eZhu Na, Hou Valve, Ge Xiaowen, et al. A small volume gastrroblastoma occurred in a 65-year-old woman [J]. Journal of Diagnosis Pathology, 2018,25 (4).\u003c/li\u003e\n\u003cli\u003eLong Weiguo, Zhuang Ying, Li Mei, Zheng Fang, Zhong Anjing, Wang Deqiang, Wu Jiannong. A case of gastruloblastoma [J]. Chinese Journal of Pathology, 2020,49 (07): 761-763.\u003c/li\u003e\n\u003cli\u003eChen Simin, Zhang Yifen, Sun Yi, Li Hui, Kefei, Wang Lu, Xie Ling. Clinicopathological observation and review of literature [J]. Journal of Diagnostic Pathology, 2022,29 (09): 858-860.\u003c/li\u003e\n\u003cli\u003eChen Qi, Zhang Yanyan, Li Yulian, Wu Liang, Li Jianmin, Chen Guorong. Gastroblastoma in 1 case [J].Journal of Clinical and Experimental pathology, 2022,38(09):1151-1152. DOI:10.13315/j. cnki.cjcep. 2022.09.033.\u003c/li\u003e\n\u003cli\u003eGraham R P, Nair A A, Davila J I, et al.Gastroblastoma harbors a recurrent somatic MALAT1\u0026ndash;GLI1 fusion gene[J].Modern Pathology, 2017, 30(10): 1443-1452.\u003c/li\u003e\n\u003cli\u003eSpans L, Fletcher C D M, Antonescu C R, et al.Recurrent MALAT1\u0026ndash;GLI1 oncogenic fusion and GLI1 up‐regulation define a subset of plexiform fibromyxoma[J].The Journal of pathology, 2016, 239(3): 335-343.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003e\u003cstrong\u003eClinicopathological characteristics of 17 gastrooblastomas reported in Table 1\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003e\u003cstrong\u003eauthor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003e\u003cstrong\u003esex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003e\u003cstrong\u003eclinlcal symptom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003e\u003cstrong\u003eposition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTumor size(cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003e\u003cstrong\u003etreat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eMiettnen et al \u003csup\u003e[1]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eAnti-force, anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e15\u0026times;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eGastrosinus resection+ postoperative radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eFor 14 years, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eMiettnen et al \u003csup\u003e[1]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eAbdominal pain, and an abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eLarge curved stomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e6\u0026times;4\u0026times;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003e5 years:disease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eMiettnen et al \u003csup\u003e[1]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eAbdominal pain, and an abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eLarge curved stomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e5\u0026times;4\u0026times;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eThe stomach was excised in large parts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 3.5 years, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003ePinto et al \u003csup\u003e[3]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eindigestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eLarge curved stomach sinus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003e1.5 years, disease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eCentonze et al \u003csup\u003e[4]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eenterorrhagid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAnd 8.4 years, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eCastri F et al\u003csup\u003e\u0026nbsp;[5]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eabdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003enot clear\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eToumi et al \u003csup\u003e[6]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eUpper abdominal pain, vomiting blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eLarge curved stomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy + splenectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eLocal recurrence in situ after 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eNa Zheng et al\u003csup\u003e\u0026nbsp;[7]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003ebloody stool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003enot clear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eSubtotal gastric resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eFor 8 months, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eYangyang Ma et al \u003csup\u003e[8]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eHemochezia, and abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e4.5\u0026times;2.5\u0026times;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eThe stomach was excised in large parts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eFor 8 months, with\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eTeresa Femand-ez et al \u003csup\u003e[9]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eAbdominal pain, radiating to the back, abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eA distal gastrectomy was performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 20 months, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eWey et al \u003csup\u003e[10]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eConstipation, and an abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eFar stomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e3.8\u0026times;3.3\u0026times;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePreoperative chemotherapy + partial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eLiver, lymph node, retroperitoneal and bladder metastases ,\u003c/p\u003e\n \u003cp\u003eThree months after surgery, the clinical condition is good\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eShin et al \u003csup\u003e[11]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eAbdominal pain, and an abdominal mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eGastric bin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e9\u0026times;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePargastric antrum + pylorus removed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 9 months, with\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;disease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eKoo\u0026nbsp;et al \u003csup\u003e[12]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eWiskott-Aldrich syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003efundus ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003e23 months: disease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eZhu na\u0026nbsp;et al\u003csup\u003e\u0026nbsp;[13]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003ePhysical examination of gastric space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eLarge curved stomach body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e1.3\u0026times;1\u0026times;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003eFull-thickness resection of the gastric wall (EPTR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eFor 4 years, with\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eLong Wei guo\u0026nbsp;et al \u003csup\u003e[14]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eThe upper abdomen is dull and painful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003eThe junction of gastric antrum and gastric body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e5.0\u0026times;4.2\u0026times;4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 14 months, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eChen Si min et al \u003csup\u003e[15]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eBlack stool, dizziness, black dark\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e2.8\u0026times;1.8\u0026times;1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 9 months, with\u0026nbsp;\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eChen Qi\u0026nbsp;et al\u003csup\u003e\u0026nbsp;[16]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003eman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eReverse the acid and make a black stool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e5.5\u0026times;5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003e2 years: disease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.982035928143713%\"\u003e\n \u003cp\u003eOur case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.88622754491018%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.485029940119761%\"\u003e\n \u003cp\u003ewoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.520958083832335%\"\u003e\n \u003cp\u003eLoss of appetite, and lost body weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.574850299401197%\"\u003e\n \u003cp\u003esinuses ventriculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.479041916167665%\"\u003e\n \u003cp\u003e8.1\u0026times;6.9\u0026times;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.107784431137723%\"\u003e\n \u003cp\u003ePartial gastrectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.964071856287426%\"\u003e\n \u003cp\u003eAt 19 months, with\u003c/p\u003e\n \u003cp\u003edisease-free survival\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"gastroblastoma, biphasic differentiation, stomach neoplasm, clinicopathologic feature","lastPublishedDoi":"10.21203/rs.3.rs-2739475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2739475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGastroblastoma (GB),a newly discovered gastric tumor with epithelial and diaphthytal differentiation,was first reported in 2009 by Miettinen et al. So far,a total of 17 cases have been reported in domestic and foreign literature,of which 13 cases were reported in the English literature,4 cases were reported in the Chinese literature,6 of 17 cases had confirmed MALAT1-GLI1 fusion gene;1 case found EWSR1-CTBP1 fusion gene. WHO (2019) included the classification of digestive system tumors for the first time. Because gastroblastoma is very rare and has a bidirectional differentiation in morphology,the differential diagnosis of them with other bidirectional tumors of the stomach (such as synovial sarcoma and sarcomatoid carcinoma) and various gastric tumors characterized by relatively mild epithelioid or spindle cells has become very difficult and easy to misdiagnosis. In this paper,a 19-year-old woman,reviewed the relevant literature,summarized the findings,discussed the clinical characteristics,pathological histology,diagnosis,differential diagnosis,treatment and prognosis,so as to improve clinical and pathological awareness of the disease,and reduce misdiagnosis and mistreatment.\u003c/p\u003e","manuscriptTitle":"Gastroblastoma without GLI1 and EWSR1 gene breaks","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-31 21:38:36","doi":"10.21203/rs.3.rs-2739475/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-05-26T03:23:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-05-17T09:48:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-05-14T15:51:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70cc94ad-7c57-4e59-b8d9-350efa17c2b4","date":"2023-05-09T06:02:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9147ca94-2638-48fd-a64a-f73d2a07c620","date":"2023-05-06T01:16:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"c953be99-df41-435a-87d5-b0cfa2ca008a","date":"2023-04-12T19:53:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-04-06T18:16:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-30T03:46:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-30T02:22:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Surgical Oncology","date":"2023-03-27T00:58:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"35d40bb2-b2f0-45de-adb4-5fb5e1516cfd","owner":[],"postedDate":"March 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:12:19+00:00","versionOfRecord":{"articleIdentity":"rs-2739475","link":"https://doi.org/10.1186/s12957-023-03159-7","journal":{"identity":"world-journal-of-surgical-oncology","isVorOnly":false,"title":"World Journal of Surgical Oncology"},"publishedOn":"2023-09-01 15:09:26","publishedOnDateReadable":"September 1st, 2023"},"versionCreatedAt":"2023-03-31 21:38:36","video":"","vorDoi":"10.1186/s12957-023-03159-7","vorDoiUrl":"https://doi.org/10.1186/s12957-023-03159-7","workflowStages":[]},"version":"v1","identity":"rs-2739475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2739475","identity":"rs-2739475","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}