44. Composite glandular-endocrine cell carcinoma of the stomach associated with non-antral gastric atrophy

Abstract

The composite glandular-endocrine cell carcinoma is a special type of gastric tumour composed of intimate admixture of ordinary adenocarcinoma and neuroendocrine cells, each component constituting a significant proportion of the tumour. We report such an extremely uncommon entity arising in an atrophic gastritis. This 40-year-old man presented with unexplained iron deficiency anaemia. Multiple gastric biopsies on microscopic examination revealed a composite tumour composed of well differentiated intestinal type adenocarcinoma admixed with carcinoid tumour. The gastric mucosa was characterised by non-antral atrophic gastritis with intestinal metaplasia, tubulovillous adenoma with mild or moderate epithelial dysplasia, foveolar hyperplasia, neuroendocrine hyperplasia and micro-carcinoid. Although the glandular and endocrine components seem to have the same histogenetic origin immunohistochemically they revealed clear cut divergences in their functional differentiation. It is likely that the pathogenesis of the this glandular-endocrine tumour stems from the loss of parietal cells in the process of atrophy with subsequent endocrine cell hyperplasia, dysplasia, neoplasia on one hand and intestinal metaplasia dysplasia carcinoma on the other. Unlike the origin and histogenesis, the clinical behaviour of this composite adenocarcinoma-carcinoid particularly arising in an atrophic gastritis remains unclear and the documented cases in the past are very few to draw a definitive conclusion.