Clinical and pathological features and treatment of nine cases of gastrointestinal composite gangliocytoma/neuroma and neuroendocrine tumor

Figure 1 Contrast-enhanced abdominal computed tomography reveals a small nodular soft tissue density lesion in the horizontal part of the duodenum, measuring approximately 1. 5 cm × 1.2 cm, which demonstrates marked enhancement after contrast administration (arrow). A: Unenhanced axial view; B: Contrast-enhanced axial view; C: Contrast-enhanced coronal view; D: Contrast-enhanced sagittal view.

Figure 2 Endoscopic image and endoscopic ultrasonography image of composite gangliocytoma/neuroma and neuroendocrine tumor (A and B in the duodenum, C and D in the rectum). A: White light endoscopy reveals a smooth-surfaced submucosal protrusion in the descending part of the duodenum, adjacent to the orifice of the major duodenal papilla; B: Endoscopic ultrasonography reveals a hypoechoic lesion arising from the muscularis propria (arrow), with heterogeneous internal echoes and a maximum cross-sectional dimension of approximately 1.64 cm × 1.54 cm. C: White light endoscopy reveals a submucosal protrusion with erythematous surface at 10 cm from the anal verge in the rectum; D: Endoscopic ultrasonography reveals a moderate to low echoic mass arising from the deep mucosa with submucosal involvement, well-defined borders, a measured cross-sectional dimension of approximately 1.35 cm × 0.91 cm, and an intact muscularis propria and adventitia.

Figure 3 Pathological and immunohistochemical features of composite gangliocytoma/neuroma and neuroendocrine tumor (from the patient shown in the previous computed tomography images). A: Pathological features of the lesion under low-power magnification (hematoxylin and eosin); B: High-power view showing spindle-shaped tumor cells arranged in fascicular sheets, nested pseudoglandular epithelioid tumor cells, and scattered ganglion-like cells with distinct nuclear membranes and prominent nucleoli (hematoxylin and eosin); C: Immunohistochemical (IHC) staining for pan-cytokeratin: Cytoplasmic positivity in epithelioid cells, with negative expression in spindle cells and ganglion-like cells; D: IHC staining for S-100: Nuclear positivity in spindle-shaped Schwann cells, with negative expression in epithelioid cells; E: IHC staining for SOX10: Nuclear positivity in spindle cells, with negative expression in epithelioid cells (in the lower right corner); F: IHC staining for synaptophysin: Diffuse cytoplasmic positivity in epithelioid cells and ganglion-like cells.

Figure 4 Pathological and immunohistochemical features of rectal composite gangliocytoma/neuroma and neuroendocrine tumor. A: Pathological features of the lesion under low-power magnification (hematoxylin and eosin); B: High-power view showing intermingled growth of spindle cells and epithelioid cells with scattered ganglion cells (hematoxylin and eosin); C: Immunohistochemical (IHC) staining for chromogranin A: Strong cytoplasmic positivity in ganglion-like cells with focal weak positivity in epithelioid cells; D: IHC staining for S-100: Cytoplasmic and nuclear positivity in spindle cells, with negative expression in epithelioid and ganglion-like cells; E: IHC staining for Ki-67: Low proliferative index; F: IHC staining for synaptophysin: Focal cytoplasmic positivity in epithelioid and ganglion-like cells.