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Namikawa T, Yokota K, Yamaguchi S, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Mibu K, Kobayashi M, Hanazaki K. Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment. Clin J Gastroenterol 2021; 14:1244-1249. [PMID: 33977396 DOI: 10.1007/s12328-021-01433-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
Grade 3, well-differentiated, gastric neuroendocrine tumors (NET G3) are extremely rare. Herein, we report the case of a 64-year-old man with a grade 3 neuroendocrine tumor of the stomach who experienced intra-abdominal bleeding during the course of drug treatment. The patient was referred to our hospital for examination of a gastric tumor that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy revealed an elevated lesion with a central ulcer in the upper body of the stomach, and biopsy specimens confirmed the pathological diagnosis of NET G3. Abdominal contrast-enhanced computed tomography (CT) showed a 25-cm, well-defined mass lesion showing heterogeneous enhancement in the liver. A clinical diagnosis of NET G3 with multiple liver metastases was given, after which everolimus was administered in combination with a somatostatin analogue. However, the patient developed sudden-onset epigastric abdominal pain and general fatigue 2 months later, and emergency abdominal contrast-enhanced CT confirmed the presence of intra-abdominal hemorrhage. Following blood transfusion, the patient's symptoms and general condition improved. Although the patient was treated with streptozocin, abdominal CT indicated progression of the liver metastases. Unfortunately, despite receiving best supportive care, the patient died 8 months after the initial of the treatment. To the best of our knowledge, this is the first case of a patient who developed spontaneous hemoperitoneum during drug treatment for a NET G3 to be reported in the English literature. It is essential that additional data be obtained to determine the optimal treatment for this disease.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kiyo Mibu
- Nursing Department, Kochi Medical School Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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2
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Ali H, Sharif M, Yasmin M, Rehmani MH, Riaz F. A survey of feature extraction and fusion of deep learning for detection of abnormalities in video endoscopy of gastrointestinal-tract. Artif Intell Rev 2019. [DOI: 10.1007/s10462-019-09743-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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3
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Zhu X, Jing H, Yao T. Clinical characteristics of early neuroendocrine carcinoma in stomach: A case report and review of literature. Medicine (Baltimore) 2019; 98:e16638. [PMID: 31348317 PMCID: PMC6709248 DOI: 10.1097/md.0000000000016638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Gastric neuroendocrine carcinoma (NEC) is rare. It is considered to be aggressive and has a poor prognosis since the diagnosis is usually made at its advanced stage. However, the survival rate is increased in some early gastric NECs. This study showed a case and reviewed the clinical characteristics of early NECs in stomach. PATIENT CONCERNS A 38-year-old man displayed no symptoms and underwent the gastric endoscopy test for his health examination, which showed a red slightly depressed lesion 1.0 cm in size on the lesser curvature of gastric cardia. Magnifying endoscopy with narrow-band imaging (NBI) revealed a clear demarcation and an irregular mesh in vessels within the depressed area. The background mucosa was negative for atrophic gastritis and Helicobacter Pylori infection. A contrast-enhanced computed tomography (CT) scan disclosed no obvious thickening of stomach and lymphadenopathy. Blood tests and physical examination were unremarkable. He had not received any surgical treatment and denied a family history of cancer and any genetic disorders. The pathologic result of biopsy from the lesion was suspicious of superficial carcinoma. Then endoscopic submucosal dissection (ESD) was performed. DIAGNOSIS Gastric NEC G3 in the early stage (T1aN0M0). INTERVENTIONS Concerning this patient's situation, we considered the ESD as a curable treatment. And no radical surgery or adjuvant chemotherapy was arranged. OUTCOMES The patient is doing well and displays no recurrence for 11 months, who is still in follow-up. LESSONS SUBSECTIONS AS PER STYLE The early diagnosis and effective treatment by endoscopy would contribute to improve the prognosis of gastric NECs.
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Affiliation(s)
| | - Haiyan Jing
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong University, Jinan 250021, China
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, Tokyo 113-8421, Japan
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4
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Cha RR, Cho JK, Kim WS, Kim JJ, Lee JM, Lee SS, Kim HJ. Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report. Clin Endosc 2018; 52:278-282. [PMID: 30300982 PMCID: PMC6547350 DOI: 10.5946/ce.2018.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/23/2018] [Indexed: 11/21/2022] Open
Abstract
Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.
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Affiliation(s)
- Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jin Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jin Joo Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
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5
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Bakogeorgos M, Kalkanis D, Katsaounis P, Ramfidis V, Speliades C, Pierrakou E, Papadopoulos S, Pantazopoulos N, Georgoulias V, Kotsakis A, Kentepozidis N. Small cell carcinoma of the stomach: A report of two cases and a review of the literature. Mol Clin Oncol 2018; 9:11-16. [PMID: 29896397 PMCID: PMC5995213 DOI: 10.3892/mco.2018.1624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/02/2017] [Indexed: 12/28/2022] Open
Abstract
Primary small cell gastric carcinomas (SCGC) are rare tumors with an aggressive nature, characterized by early, widespread metastases and poor overall prognosis. SCGC shares similar clinicopathological and molecular characteristics with small cell lung carcinoma and is usually treated in a similar manner. Here, two cases of SCGC in young Caucasian male patients are presented. One patient had metastatic and the other locoregional disease. Multimodal treatment was applied in each case; the resulting survival time was 20.2 months in the patient with initially locoregional disease whereas the remains alive and disease-free 20 months after initial diagnosis. A review of the literature is also presented.
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Affiliation(s)
- Marios Bakogeorgos
- Department of Medical Oncology, 251 General Air Force Hospital, 11525 Athens, Greece
| | - Dimitrios Kalkanis
- Department of Nuclear Medicine, 251 General Air Force Hospital, 11525 Athens, Greece
| | | | - Vassilios Ramfidis
- Department of Medical Oncology, 251 General Air Force Hospital, 11525 Athens, Greece
| | | | | | | | | | - Vassilis Georgoulias
- First Department of Medical Oncology, Iaso General Hospital, 11562 Athens, Greece
| | - Athanasios Kotsakis
- Department of Medical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Nikolaos Kentepozidis
- Department of Medical Oncology, 251 General Air Force Hospital, 11525 Athens, Greece
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6
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Kusunoki R, Fujishiro H, Onoda Y, Suemitsu S, Fujiwara A, Tsukano K, Kotani S, Kuroki D, Ogawa S, Yamanouchi S, Aimi M, Ito S, Miyaoka Y, Miyake T, Kohge N, Imaoka T, Takamura M, Ohnuma H, Ishihara S, Kinoshita Y. Large-cell neuroendocrine carcinoma arising from a gastritis cystica polyposa. Clin J Gastroenterol 2018; 11:133-137. [PMID: 29305822 DOI: 10.1007/s12328-017-0816-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/27/2017] [Indexed: 12/30/2022]
Abstract
Gastritis cystica polyposa is a polypoid lesion that arises from the gastric mucosa at the gastrojejunal anastomotic site and is characterized by cystic dilation of the gastric glands. A 78-year-old man who underwent distal gastrectomy for a gastric ulcer with Billroth II reconstruction approximately 40 years previously, exhibited a gastritis cystica polyposa at the anastomotic site. Ulceration was observed on an annual endoscopic examination. Endoscopic ultrasonography revealed a submucosal hypoechoic mass with multiple cystic lesions. Gastrectomy was performed and histological examination revealed a large-cell neuroendocrine carcinoma with cystic dilation of the gastric glands. Here, we report the first case of a large-cell neuroendocrine carcinoma arising from a gastritis cystica polyposa. Endoscopic ultrasonography was effective at diagnosing a submucosal hypoechoic mass with cystic dilation of the gastric glands.
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Affiliation(s)
- Ryusaku Kusunoki
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
| | - Hirofumi Fujishiro
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Yuji Onoda
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Shinsuke Suemitsu
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Aya Fujiwara
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Kousuke Tsukano
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Satoshi Kotani
- Departments of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Daisuke Kuroki
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Sayaka Ogawa
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Satoshi Yamanouchi
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Masahito Aimi
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Satoko Ito
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Youichi Miyaoka
- Departments of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Tatsuya Miyake
- Departments of Hepatology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Naruaki Kohge
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Tomonori Imaoka
- Departments of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Michio Takamura
- Departments of Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hideyuki Ohnuma
- Departments of Pathology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine 2, Shimane University School of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine 2, Shimane University School of Medicine, Izumo, Japan
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7
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Collision tumor of choriocarcinoma and small cell carcinoma of the stomach: A case report. Int J Surg Case Rep 2017; 37:216-220. [PMID: 28709051 PMCID: PMC5508625 DOI: 10.1016/j.ijscr.2017.06.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/25/2022] Open
Abstract
We detailed a collision tumor of gastric choriocarcinoma and small cell carcinoma. We found a clear colliding point between choriocarcinoma and small cell carcinoma. Immunohistochemical staining results of HER2 were different for the two components.
Introduction Both gastric choriocarcinoma and small cell carcinoma are extremely rare, both accounting for approximately 0.1% of all gastric cancers. Therefore, simultaneous occurrence of gastric choriocarcinoma and small cell carcinoma is even rarer. Presentation of case An 84-year-old Japanese man was referred to our hospital with the chief complaint of dysphagia. Laboratory data showed iron deficiency anemia. Contrast-enhanced computed tomography of the abdomen revealed thickened wall of the stomach at the fundus and several enlarged abdominal lymph nodes. Upper gastrointestinal endoscopy showed a friable gastric tumor with necrosis in the gastric cardia extending to the abdominal esophagus. Small cell carcinoma was diagnosed based on pathological examination of biopsy specimens. The anemia, which was probably because of tumor bleeding, progressed despite repeated transfusion; therefore, a semi-urgent laparotomy was performed to control hemorrhage. Finally, total gastrectomy and lymph node resection were performed. Based on pathological findings, a diagnosis of collision tumor of choriocarcinoma and small cell carcinoma of the stomach was confirmed. Discussion When encountering large tumors with necrosis or hemorrhage in the stomach, the possibility of choriocarcinoma component should be considered. Moreover, when small cell carcinoma is morphologically suspected, even if slightly, additional immunohistochemical staining must be performed. Conclusion This report detailed an extremely rare case of collision tumor of choriocarcinoma and small cell carcinoma of the stomach.
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8
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The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85:1117-1132. [PMID: 28385194 DOI: 10.1016/j.gie.2017.02.022] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
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9
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Lai JH, Chang YC, Lin CC. Primary Gastric Small Cell Carcinoma in Elderly Patients: A Case Report and Review of the Literature. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Garcia-Carbonero R, Sorbye H, Baudin E, Raymond E, Wiedenmann B, Niederle B, Sedlackova E, Toumpanakis C, Anlauf M, Cwikla JB, Caplin M, O'Toole D, Perren A. ENETS Consensus Guidelines for High-Grade Gastroenteropancreatic Neuroendocrine Tumors and Neuroendocrine Carcinomas. Neuroendocrinology 2016; 103:186-94. [PMID: 26731334 DOI: 10.1159/000443172] [Citation(s) in RCA: 378] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- R Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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11
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Grin A, Streutker CJ. Neuroendocrine tumors of the luminal gastrointestinal tract. Arch Pathol Lab Med 2015; 139:750-6. [PMID: 26030244 DOI: 10.5858/arpa.2014-0130-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Neuroendocrine tumors (NETs) of the gastrointestinal tract have been recognized for more than a century. Despite histologic similarities between different sites in the tract, behavior varies between areas. All of these tumors have malignant potential, but determination of exact risk is difficult. OBJECTIVES To review the diagnosis of luminal gastrointestinal NETs, including a discussion of grading. Grading by mitotic index/activity, in conjunction with tumor size/stage, has been found to be the strongest predictor of behavior. DATA SOURCES Literature review of luminal gastrointestinal NETs was performed and the results summarized. CONCLUSIONS Our understanding of these lesions is incomplete and continues to evolve.
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Affiliation(s)
- Andrea Grin
- From the Department of Laboratory Medicine and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Gastric mixed adenoneuroendocrine carcinoma with thyroid transcription factor-1-positive neuroendocrine component. Clin J Gastroenterol 2015; 8:82-7. [DOI: 10.1007/s12328-015-0562-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/04/2015] [Indexed: 01/04/2023]
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13
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Yazıcı O, Ozdemir NY, Sendur MAN, Aksoy S, Zengin N. Current approaches for prophylactic cranial irradiation in extrapulmonary small cell carcinoma. Curr Med Res Opin 2014; 30:1327-36. [PMID: 24628530 DOI: 10.1185/03007995.2014.904771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) patients, who have achieved complete or partial response after chemotherapy, should be followed with prophylactic cranial irradiation (PCI). PCI for extrapulmonary small cell carcinoma (EPSCC) is not routinely recommended. The purpose of this review is to discuss all aspects of PCI in management of EPSCC. SCOPE The PubMed database and the database of online abstracts of the American Society of Oncology (ASCO), ASCO Genitourinary (GU) Cancers meetings and clinical trials were searched up to 15 October 2013 using the following search keywords: 'SCC or EPSCC of each organ site and prophylactic cranial radiotherapy'. The language of screened abstracts and manuscripts was limited to English. The papers which included the largest case series and data of cases about prophylactic cranial radiotherapy and/or were published in the last 10 years were selected. FINDINGS Many single center studies showed low incidence of brain metastasis in patients with esophageal small cell carcinoma (SCC). Due to the low incidence of brain metastasis, PCI is not recommended for esophageal SCC. Genitourinary, colorectal, small bowel and appendix cranial metastatic SCCs are extremely rare. Therefore, PCI is not recommended. The frequency of brain metastasis of prostate small cell carcinoma is much higher (16-19%) compared to other counterparts of EPSCC. PCI can be performed in selected cases of prostate SCC. High rates (41%) of brain metastasis develop in head and neck SCC. PCI should be considered for patients with head neck SCC. CONCLUSION In the literature, the brain metastasis incidence of EPSCC might vary from 1.7% up to 40%. In many patients with ESPCC, PCI is not recommended. However, we have to keep in mind that primary head and neck and prostate SCC are exceptions due to the high incidence of cranial metastasis; PCI should be recommended for these patients on an individual basis.
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Affiliation(s)
- Ozan Yazıcı
- Ankara Numune Education and Research Hospital , Ankara , Turkey
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14
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15
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The role of 68-Ga-DOTATOC CT-PET in surgical tactic for gastric neuroendocrine tumors treatment: our experience: a case report. Int J Surg 2014; 12 Suppl 1:S225-31. [PMID: 24862665 DOI: 10.1016/j.ijsu.2014.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 01/15/2023]
Abstract
Gastric neuroendocrine tumors (g-NETs), which originate from gastric enterochromaffin-like (ECL) mucosal cells and account for 2.4% of all carcinoids, are increasingly recognized due to expanding indications of upper gastrointestinal endoscopy. Often silent and benign, g-NETs may however, be aggressive and sometimes they mimic the course of gastric adenocarcinoma. Current nosography distinguishes those occurring in chronic conditions with hypergastrinemia, as the type 1 associated with chronic atrophic gastritis, and the type 2 associated with Zollinger-Ellison syndrome in MEN1. Conversely, type 3 and 4 (according to some authors) are unrelated to hypergastrinemia and are frequently malignant, with a propension to develop distant metastases. While there is a general agreement concerning the treatment of malignant gastric neuroendocrine tumors, for types 1 and 2, current possibilities include surveillance, endoscopic polypectomy, surgical excision, associated or not with surgical antrectomy, or total gastrectomy. This report, based on our clinical experience, discusses how the size, number, depth, histological grading, staging with CT, MRI, and the use of recently developed somatostatin receptor tracers (68Ga-DOTATATE, 68Ga-DOTA-TOC) could allow the correct identification of a benign or malignant propensity of an individual tumor, thus avoiding underestimation or overtreatment of these uncommon neoplasms.
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16
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Funahashi H, Miyai H, Wakasugi T, Ishiguro H, Matsuo Y, Kimura M, Takeyama H. Successful combination chemotherapy with irinotecan hydrochloride and cisplatin for primary gastric small cell carcinoma: report of a case. World J Surg Oncol 2013; 11:263. [PMID: 24099520 PMCID: PMC3852596 DOI: 10.1186/1477-7819-11-263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/27/2013] [Indexed: 12/29/2022] Open
Abstract
Primary gastric small cell carcinoma is a rare and aggressive malignant disease with a poor prognosis that was first reported in 1976 by Matsusaka et al. The incidence is very low and the clinicopathological features are similar to those of small cell lung carcinoma. We herein report a case of successful treatment by combination chemotherapy consisting of irinotecan hydrochloride and cisplatin for primary gastric small cell carcinoma. The patient was a 71-year-old male who was admitted to a local hospital with anemia. Gastrointestinal endoscopy revealed the presence of advanced gastric carcinoma at the upper region of the stomach. The patient underwent surgery, and the pathological diagnosis was small cell carcinoma due to the presence of the typical features of small round cells with scant cytoplasm that were positive for synaptophysin and chromogranin A in the resected specimen. The patient underwent subsequent combination chemotherapy, which provided him with over 1 year of survival and a good quality of life. We also present a review of the literature regarding chemotherapy for primary gastric small cell carcinoma.
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Affiliation(s)
- Hitoshi Funahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 4678601, Japan.
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17
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Kim BS, Oh ST, Yook JH, Park YS, Kim BS. Primary Small Cell Carcinoma of the Stomach: Clinical Outcomes and Prognoses. Am Surg 2013. [DOI: 10.1177/000313481307900909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Beom Su Kim
- Department of Surgery Asan Medical Center University of Ulsan College of Medicine Seoul, Korea
| | - Seong Tae Oh
- Department of Surgery Asan Medical Center University of Ulsan College of Medicine Seoul, Korea
| | - Jeong Hwan Yook
- Department of Surgery Asan Medical Center University of Ulsan College of Medicine Seoul, Korea
| | - Young Soo Park
- Department of Pathology Asan Medical Center University of Ulsan College of Medicine Seoul, Korea
| | - Byung Sik Kim
- Department of Surgery Asan Medical Center University of Ulsan College of Medicine Seoul, Korea
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18
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Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K. Neuroendocrine carcinoma of the stomach: clinicopathological and immunohistochemical evaluation. Med Mol Morphol 2013; 46:34-40. [PMID: 23306663 DOI: 10.1007/s00795-012-0006-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/27/2012] [Indexed: 02/07/2023]
Abstract
Neuroendocrine carcinoma (NEC) of the stomach is an uncommon disease. Because of its rarity, the clinicopathological features are unclear, and there is no consensus on the optimal treatment strategy. This study included five consecutive patients with gastric NEC who underwent surgery from July 2001 to August 2011. Clinical presentation, tumor location, tumor morphology and size, pathology and immunohistochemistry results, and treatment outcome were analyzed retrospectively and discussed. The study cohort of four men and one woman ranged in age from 52 to 84 years, with a median age of 72 years. Positive rates of neuroendocrine markers were 40 % for chromogranin A, 60 % for synaptophysin, 60 % for CD56, 40 % for neuron-specific enolase, and 100 % for p53 protein. Median number of lymph node metastases per patient was 10, with severe lymphatic and venous infiltration, and high Ki-67 labeling index (60-90 %) reported for all patients. Median tumor size was 6 cm. Stage IV disease was diagnosed in three patients; the other two patients showed stage IIIA tumors. After a mean follow-up of 29.8 months, two of the five patients had died of the disease. Although rare, gastric NECs deserve particular attention because of their strong malignant potential associated with an extremely poor prognosis. Such carcinomas demand an aggressive surgical approach followed by chemotherapy and multimodality adjuvant therapy.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, Japan.
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Kou T, Takayama W, Nishimori T, Kakuta S, Yanagibashi H, Kobayashi S, Sugaya M. Curative Operation of Liver Metastasis Six Months After Total Gastrectomy for Early Small Cell Carcinoma of the Stomach. ACTA ACUST UNITED AC 2013. [DOI: 10.5833/jjgs.2012.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Synchronous occurrence of early neuroendocrine carcinoma and tubular adenocarcinoma in the stomach. Clin J Gastroenterol 2012; 5:307-11. [PMID: 26182399 DOI: 10.1007/s12328-012-0320-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/27/2012] [Indexed: 12/29/2022]
Abstract
This report describes a patient with early neuroendocrine carcinoma (NEC) and tubular adenocarcinoma in the stomach. A 74-year-old Japanese male experienced epigastralgia. Endoscopic examination revealed two small lesions; one was an elevated lesion with ulceration at the posterior wall of the pre-pylorus and the other was a depressed lesion at the greater curvature of the antrum. Pathological diagnosis of the biopsies indicated poorly differentiated adenocarcinoma from the lesion on the pre-pylorus and well differentiated adenocarcinoma from the lesion on the antrum. He was referred to the surgical outpatient clinic with early double cancer of the stomach. A distal partial gastrectomy with lymph node dissection was performed. A histopathological examination revealed NEC at the lesion on the pre-pylorus and well differentiated tubular adenocarcinoma at the lesion on the antrum. These two lesions were completely separate from each other. Therefore, this case is thought to demonstrate the synchronous occurrence of early NEC and tubular adenocarcinoma in the stomach.
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Kubota T, Ohyama S, Hiki N, Nunobe S, Yamamoto N, Yamaguchi T. Endocrine carcinoma of the stomach: clinicopathological analysis of 27 surgically treated cases in a single institute. Gastric Cancer 2012; 15:323-30. [PMID: 22252152 DOI: 10.1007/s10120-011-0122-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 11/26/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric endocrine carcinoma (EC) is an uncommon tumor of the stomach and the clinical features are not well known. Additionally, the classification and staging systems of this tumor are not yet unified worldwide. In this study, we reviewed 27 patients with gastric EC to evaluate the clinicopathological characteristics of this tumor. METHODS We retrospectively reviewed 27 patients with gastric EC among 6466 patients who had undergone gastrectomy between 1986 and 2008 at our institute. Clinicopathological features including immunohistochemistry of Ki-67 were investigated to evaluate the malignant potential of the tumor. Furthermore, survivals were compared between the 7th edition of the International Union Against Cancer (UICC)-TNM (7th TNM) classification for gastric cancer (GC) and the new TNM classification for foregut neuroendocrine tumors (NET). RESULTS The median survival of the patients was 19.0 months. The 5-year survival rate was 100% in pathological stage (pStage) I, 40% in pStage II, 38% in pStage III, and 11% in pStage IV according to the 7th TNM classification for GC. Survivals by stage showed great difference between the 7th TNM classification for GC and the new TNM classification for foregut NET, but each system correlated with survival. The Ki-67 labeling index was more than 20% in most of the patients. Univariate analysis revealed that maximum tumor diameter, tumor depth, lymph node metastasis, lymphatic invasion, pStage, and curability had significant correlations with survival. CONCLUSION Early detection and curative operations are essential for improving the prognosis of gastric EC. However, some adjuvant chemotherapies are required for advanced-stage tumors. Classification and staging systems may need to be unified worldwide for further analysis.
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Affiliation(s)
- Takeshi Kubota
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Huang J, Zhou Y, Zhao X, Zhang H, Yuan X, Wang J. Primary small cell carcinoma of the stomach: an experience of two decades (1990-2011) in a Chinese cancer institute. J Surg Oncol 2012; 106:994-8. [PMID: 22674018 DOI: 10.1002/jso.23186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/14/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary gastric small cell carcinoma (GSCC) is a rare and aggressive disease for which the standard treatment has not been established. The objective of this study is to investigate the clinical characteristics and survival. METHODS All cases of GSCC treated at our institute from January 1990 to December 2011 were reviewed and analyzed retrospectively. Statistical analyses were performed using Fisher's exact test. RESULTS A total of 19 patients from 11,603 cases (0.16%) of all gastric cancers treated during this period were identified. The median age was 61 years and the patients were predominantly men. Using the latest AJCC Staging Criteria, the majority of the patients (68.4%) were Stage III. All patients underwent surgery. The median overall survival time (MST) was 19.5 months (95% CI 17.5-21.6 months). The 1-, 3-, and 5-year overall survival rates were 77.3%, 44.2%, and 22.1%, respectively. The MST of 48.5 months for cases who received postoperative adjuvant chemotherapy was superior to that of 19.0 months for cases who did not (P = 0.026). CONCLUSIONS Our data indicate that GSCC patients can be treated effectively with combined modality of treatment, despite the aggressive nature of GSCC. Systemic therapy, based on chemotherapy with surgery, is recommended.
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Affiliation(s)
- Jing Huang
- Department of Medical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China.
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Abe T, Shigeta N, Yoshifumi T, Mukai S, Mitsuta H, Tanji H, Shinya K, Sumimoto K. Gastric endocrine cell carcinoma with long-term survival developing metachronous remnant cancer. Case Rep Gastroenterol 2011; 5:117-21. [PMID: 21512616 PMCID: PMC3080582 DOI: 10.1159/000326961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A rare case of primary gastric endocrine cell carcinoma in a 79-year-old man is reported. Upper gastrointestinal endoscopy showed a large Bormann's type 2 tumour located in the middle of the stomach. On computed tomography, the gastric wall was thickened by the large tumour, and there were no distant metastases. Distal gastrectomy, lymph node dissection, and partial resection of the transverse colon were performed because the tumour involved the transverse mesocolon. The final pathological diagnosis was endocrine cell carcinoma, with tumour infiltration up to the subserous layer. Adjuvant chemotherapy was given, but metachronous remnant gastric cancer developed 2 years after surgery. Endoscopic submucosal dissection was performed for the early 0-IIc type gastric cancer, and the surgical margin was preserved. The patient has survived for 5 years after the primary surgery, remaining disease-free so far.
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Affiliation(s)
- Tomoyuki Abe
- Department of Surgery, Yoshida General Hospital, Akitakata, Japan
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Unusual case of small cell gastric carcinoma: case report and literature review. Dig Dis Sci 2011; 56:951-7. [PMID: 20848201 DOI: 10.1007/s10620-010-1404-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 08/12/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small cell carcinomas are among the most aggressive, poorly differentiated, and highly malignant of the neuroendocrine tumors (NETs). Of which, small cell gastric carcinoma is a rare small cell neuroendocrine tumor. The purpose of our study was to present this case and perform a comprehensive literature review. METHODS AND RESULTS We review a case of small cell gastric carcinoma that is particularly unusual in that it occurred in a woman from the US when the majority of cases of small cell gastric carcinoma have been reported in men from East Asia, and more specifically, from Japan. The diagnosis was made after endoscopy revealed a large ulcerated mass in the gastric cardia of Borrmann type 3. Biopsies revealed multiple small basophilic cells underlying the squamous epithelium of the esophagus and cardiac mucosa, indicating the presence of a tumor at the gastroesophageal junction. Immunostaining established the diagnosis with positive stains for chromogranin, synaptophysin, and CD56. Our patient is being treated with chemotherapy, but many different treatment regimens have been tried for small cell gastric carcinoma with variable success. CONCLUSIONS Overall prognosis for small cell gastric carcinoma is dismal. Neuroendocrine tumors in general have variable clinical behaviors and prognosis is dependent on the neuroendocrine tumor type. The adoption of a standardized classification system for neuroendocrine tumors could improve the recognition of infrequently encountered neuroendocrine tumors like small cell gastric carcinoma and will enhance strategies for treatment and thus improve prognosis for patients with these rare and aggressive tumors.
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Lawrence B, Kidd M, Svejda B, Modlin I. A clinical perspective on gastric neuroendocrine neoplasia. Curr Gastroenterol Rep 2011; 13:101-109. [PMID: 21080245 DOI: 10.1007/s11894-010-0158-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The incidence of gastric neuroendocrine tumors (NETs) has increased exponentially based on widespread use of endoscopy and a greater pathological awareness of the condition. A key concern is the potential association with hypergastrinemia induced by proton pump inhibitor administration. Previous confusion regarding diagnosis and therapy has been diminished by a series of international consensus statements defining the biology and management strategies for the disease. Overall, gastric NETs are categorized as well-differentiated or poorly differentiated neoplasms. Well-differentiated gastric NETs are enterochromaffin-like (ECL) cell tumors subclassified into three types based on their relationship to gastrin, a key regulator of ECL cell neoplastic transformation. The treatment of type 1 and type 2 tumors depends on the size and invasiveness of the tumor, whereas type 3 tumors and poorly differentiated neuroendocrine carcinomas warrant aggressive surgical resection. The disease-specific 5-year survival ranges from about 95% in type 1 gastric carcinoids to about 25% in poorly differentiated gastric NECs. Elucidation of the precise biology of a gastric NET is critical to diagnosis and delineation of a type-specific management strategy.
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Affiliation(s)
- Ben Lawrence
- Yale University School of Medicine, New Haven, CT 06520, USA.
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Moise D, Singh J, Dahl K, Rashid S, Prasad A, Siddiqui G, Subramani K, Mustacchia P, Rizvon K. Extrapulmonary Small Cell Carcinoma of the Stomach: A Lethal Entity. Case Rep Gastroenterol 2010; 4:298-303. [PMID: 21060733 PMCID: PMC2974988 DOI: 10.1159/000314821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extrapulmonary small cell carcinoma of the stomach is a rare and aggressive malignancy with a poor prognosis that was first described in 1976 by Matsusaka et al. In 1989 it was recognized by the World Health Organization as an independent entity affecting the stomach. Pure and composite are the two types of gastric small cell carcinoma reported in the literature. We report a case of a 68-year-old African American male with metastatic pure-type extrapulmonary small cell cancer of the stomach. The primary lesion measured approximately 7 cm in diameter on endoscopy. The diagnosis was made on the basis of characteristic histological features of small, round, oval lymphocyte-like cells with hyperchromatic nuclei, and scant cytoplasm consistent with small cell carcinoma. Gastric small cell carcinoma is typically diagnosed at an advanced stage as demonstrated in our case. We conducted a literature review discussing the two types of extrapulmonary small cell carcinoma of the stomach and their prevalence.
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Affiliation(s)
- Duane Moise
- Department of Gastroenterology, Nassau University Medical Center, East Meadow, N.Y., USA
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A rare case of poorly differentiated endocrine cell carcinoma of the stomach with signet ring cell differentiation. Gastric Cancer 2010; 13:131-4. [PMID: 20602201 DOI: 10.1007/s10120-009-0540-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 12/25/2009] [Indexed: 02/07/2023]
Abstract
There have been few reports of the dual differentiation of different cell types within the same gastric tumor. Here, we report a rare case of poorly differentiated endocrine cell carcinoma with an associated differentiated signet ring cell population arising in the stomach. The histological appearance of the tumor by light microscopy matched the phenotype of endocrine cell carcinoma and signet ring cell differentiation with mucinous lakes. Cells with a phenotype intermediate between the two differentiated cell types were also seen in the tumor. Both the endocrine cell carcinoma and the signet ring cells were diffusely positive for chromogranin A and synaptophysin, a finding that is consistent with endocrine differentiation by immunohistochemical examination. The patient's postoperative clinical course had a poor prognosis, with aggressive tumor progression. Paraaortic lymph node recurrence was found 6 months after the operation, and the patient died of the primary disease 16 months after the surgical treatment.
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Katano T, Takahashi Y, Miyamoto T. An autopsy case of primary small cell gastric carcinoma and adenocarcinoma. Clin J Gastroenterol 2010; 3:144-8. [PMID: 26190121 DOI: 10.1007/s12328-010-0153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
A 62-year-old man was emergently admitted to our hospital because of disturbance of consciousness. Computed tomography of the chest and abdomen showed pleural effusion, ascites, and generalized lymphadenopathy. Upper gastrointestinal endoscopy revealed bleeding from an irregular ulcerative lesion in the lesser curvature of the middle portion of the gastric body, and exhibited the morphology of Borrman type 4 gastric cancer. The patient died on the seventh hospital day. At autopsy, a diagnosis of primary small cell gastric carcinoma associated with adenocarcinoma was made. Primary small cell gastric carcinoma and its coexistence with adenocarcinoma, as in this case, is rare.
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Affiliation(s)
- Takahito Katano
- Department of Internal Medicine, Chita Kosei Hospital, 81-6 Nishitani, Kowa, Mihama-cho, Chita-gun, Aichi, Japan.
| | - Yoshitsugu Takahashi
- Department of Internal Medicine, Chita Kosei Hospital, 81-6 Nishitani, Kowa, Mihama-cho, Chita-gun, Aichi, Japan
| | - Tadahisa Miyamoto
- Department of Internal Medicine, Chita Kosei Hospital, 81-6 Nishitani, Kowa, Mihama-cho, Chita-gun, Aichi, Japan
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Simultaneous thoracotomy and laparotomy for small cell carcinoma of oesophagogastric junction. ANZ J Surg 2008; 78:723-4. [DOI: 10.1111/j.1445-2197.2008.04633.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nilsson O, Van Cutsem E, Delle Fave G, Yao JC, Pavel ME, McNicol AM, Sevilla Garcia MI, Knapp WH, Keleştimur F, Sauvanet A, Pauwels S, Kwekkeboom DJ, Caplin M. Poorly differentiated carcinomas of the foregut (gastric, duodenal and pancreatic). Neuroendocrinology 2006; 84:212-5. [PMID: 17312381 DOI: 10.1159/000098013] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ola Nilsson
- Department of Pathology, Gothenburg University, Gothenburg, Sweden.
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