Abstract
A 69-year-old female presented to our institution with epigastralgia and abdominal distension. Upper gastrointestinal series revealed a 5 cm ulcerative lesion with irregular margins and elevated distinct borders from the angle to the pyloric ring. Gastroendoscopy revealed a Borrmann type 2 tumor. Several biopsied specimens revealed proliferation of small and heterogeneous cancer cells with rich chromatin and fibrous septum with rich vessels at connective tissues, which was confirmed as gastric endocrine cell carcinoma (ECC) on immunostaining with chromogranin and synaptophysin. Furthermore, other specimens revealed atypical cells forming glandular structures, which were confirmed as well-differentiated tubular adenocarcinomas. Distal gastrectomy with D2 lymph node dissection and Billroth I reconstruction was performed. Pathological examination of the gross specimen revealed that adenocarcinoma comprised <10% of all cancer cells. Close analysis of ECC revealed a mixture of small and large cells. According to the WHO 2010 classification of gastrointestinal neuroendocrine tumors, this gastric tumor was diagnosed as neuroendocrine carcinoma. The patient was administered adjuvant chemotherapy with cisplatin and etoposide. One year following surgery, follow-up abdominal CT revealed multiple liver metastases. The patient received the best supportive care but eventually died 18 months after surgery. Here we present this case of gastric ECC coexistent with adenocarcinoma.
Highlights
Gastric endocrine cell carcinoma (ECC), characterized by endocrine differentiation and aggressive biological behavior, is occasionally accompanied by the presence of adenocarcinoma cells
On the basis of the analysis of p53 gene alteration, the hypothesis that was derived proved that adenocarcinoma cells have the potential to develop into gastric ECC [1]
The tumor comprised two different parts: ulcers with severe invasiveness and smooth protrusion from the endocrine cells and well-differentiated adenocarcinoma cells, as revealed by specimens biopsied under gastroendoscopy
Summary
Gastric endocrine cell carcinoma (ECC), characterized by endocrine differentiation and aggressive biological behavior, is occasionally accompanied by the presence of adenocarcinoma cells. On the basis of the analysis of p53 gene alteration, the hypothesis that was derived proved that adenocarcinoma cells have the potential to develop into gastric ECC [1]. We present a case of gastric ECC coexistent with adenocarcinoma as well as p53 gene analyses of ECC and adenocarcinoma
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