Abstract
Mixed adeno-neuroendocrine carcinoma is a rare tumor of the gastrointestinal tract comprising of both epithelial and neuroendocrine components, each representing at least 30% of the tumor. Diagnosis is based on clinical evaluation, radiological findings, histopathological features in conjunction with immunostaining with specific neuroendocrine markers such as chromogranin, synaptophysin, CD56, and markers of epithelial differentiation such as cytokeratin, CDX2, and carcinoembryonic antigen. A 50-year-old female presented with a history of dysphagia, chest pain, anorexia, and significant weight loss with normal physical findings and baseline investigations. Upper Gastrointestinal endoscopy showed growth at the gastroesophageal junction involving cardia of the stomach. Histopathological examination of the resected mass showed both adenocarcinoma and neuroendocrine carcinomatous components each involving more than 30% of total mass examined. Identifying adenocarcinoma component admixed with a high-grade neuroendocrine component is significant as the prognosis and survival of patients differ from pure adenocarcinoma.
Highlights
Mixed neuroendocrine-non neuroendocrine neoplasm (MiNEN) is defined as a mixed epithelial neoplasm composed of both neuroendocrine and non-neuroendocrine components with variable proportions of each component
In the 2019 WHO classification of tumors of the digestive tract, mixed exocrine-neuroendocrine carcinomas are defined as MiNEN which is further classified as mixed adenocarcinoma-NEC (MANEC) and mixed adenocarcinoma-NET depending on the grade of the neuroendocrine component.[1]
There is a wide spectrum of a combination of nonneuroendocrine and neuroendocrine components in the gastrointestinal tract, ranging from neuroendocrine neoplasms with a focal exocrine component at one extreme to exocrine carcinomas with interspersed neuroendocrine cells at the other
Summary
Mixed adenoneuroendocrine carcinoma of proximal stomach; a rare but sinister pathology. Mixed adeno-neuroendocrine carcinoma is a rare tumor of the gastrointestinal tract comprising of both epithelial and neuroendocrine components, each representing at least 30% of the tumor. Diagnosis is based on clinical evaluation, radiological findings, histopathological features in conjunction with immunostaining with specific neuroendocrine markers such as chromogranin, synaptophysin, CD56, and markers of epithelial differentiation such as cytokeratin, CDX2, and carcinoembryonic antigen. Upper Gastrointestinal endoscopy showed growth at the gastroesophageal junction involving cardia of the stomach. Histopathological examination of the resected mass showed both adenocarcinoma and neuroendocrine carcinomatous components each involving more than 30% of the total mass examined. Identifying adenocarcinoma component admixed with a high-grade neuroendocrine component is significant as the prognosis and survival of patients differ from pure adenocarcinoma. Mixed Adenoneuroendocrine carcinoma of proximal stomach; a rare but sinister pathology.
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