2773 Gastric Small Cell Cancer: An Extremely Rare and Lethal Type of Stomach Cancer

Abstract

INTRODUCTION: Small cell carcinoma commonly originates in the lung, but it can also arise from many extrapulmonary sites including the stomach. Gastric small cell carcinomas (GSCC) are extremely rare and comprise less than 0.1% of all gastric cancers. GSCC has aggressive clinical course with early metastases. The median survival time for localized disease is 1.4 to 3.5 years. We report a rare case of metastatic gastric small cell cancer in an elderly female. CASE DESCRIPTION/METHODS: A 79-year-old African American female with past medical history of hypertension presented with vomiting and 15-pound weight loss over 2 months. She also reported solid food dysphagia for 2 weeks. CT abdomen showed innumerable hypodense lesions throughout the liver, compatible with metastases and several necrotic appearing enlarged lymph nodes in the gastrohepatic ligament. EGD revealed a single cratered and linear ulcer on the lesser curvature of body of the stomach 3 cm below the gastroesophageal junction (Figure 1). It measured 8 × 1.5 cm in size. Multiple biopsies were taken. EUS showed multiple discrete hyperechoic lesions in the left lobe of the liver consistent with liver metastases (Figure 2). Liver biopsy was performed. Biopsy suggested invasive small cell carcinoma with necrosis. CT chest was negative for lung cancer. Bone scan showed multiple focal bony lesions consistent with bone metastases. Patient was started on chemotherapy by oncology for stage IV small cell gastric cancer. Unfortunately, the patient died within few months of initial diagnosis. DISCUSSION: GSCC is very rare and it was first reported in 1976. It has poor prognosis even in patients with localized disease. Epigastric pain, dysphagia and melena are common clinical presentations of GSCC. GSCC frequently metastasize to the liver, followed by lymph nodes and bones. Surgical resection is considered standard therapy for localized disease. Chemotherapy can increase median survival from 6 to 12 months for advanced disease. Early recognition and treatment of small cell gastric cancer in very important as advanced disease has dismal prognosis and it is universally fatal.