Synchronous occurrence of early neuroendocrine carcinoma and tubular adenocarcinoma in the stomach

An Intestinal Type Gastric Neuroendocrine Tumor: A Case Report

Neuroendocrine tumors (NETs) represent a diverse set of malignancies, originating from the neuroendocrine cells dispersed throughout the body. Their symptoms are associated with the secretion of bioactive peptides by tumor cells. Five-year survival rates depend on the disease stage: 93% for local, 74% for regional, and 19% for metastatic disease. This report describes a case involving a 64-year-old male patient, who was enduring high blood pressure and anemia. His symptomatology included frequent fainting and bloody vomiting without prior bleeding, coupled with persistent abdominal pain and weight loss. A complete blood count revealed microcytic anemia. His condition improved postoperatively after the transfusion of two units of packed red blood cells, normalizing all parameters. Further biochemistry and serology tests did not provide significant insights. However, an upper endoscopy unveiled a deep ulcer below the gastroesophageal junction with ulcer desquamation. A combination of clinical, laboratory, and radiographic data initially indicated a gastric carcinoma of the intestinal type, characterized by extensive extracellular mucin secretion. The surgical intervention led to the extraction of multiple tumors from lymph nodes, culminating in a postoperative diagnosis of a gastrointestinal (GI) mesenchymal tumor. NETs predominantly manifest in the GI tract, initiating primarily in the small intestine but can also originate in the stomach, appendix, colon, and other parts of the GI tract. Their development from neuroendocrine cells enables them to produce high concentrations of hormone-like substances such as neuropeptides and amines.

Clinical characteristics of early neuroendocrine carcinoma in stomach: A case report and review of literature

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.

Neuroendocrine neoplasms of gastrointestinal tract and secondary primary synchronous tumors: A systematic review of case reports. Casualty or causality?

BACKGROUND

Neuroendocrine neoplasms (NENs) can arise in most of the epithelial organs of the body and are not a rare condition in the gastrointestinal tract (GIT). The presence of NENs in GIT associated with other secondary primary malignancies (SPM) has been considered an exotic event. This study aims to describe the case reports of NENs accompanied by synchronous primary tumors.

METHODS AND FINDINGS

We performed a systematic literature search of the databases Scopus, PubMed, Scielo and LILACS to identify case reports that described the presence of NENs in GIT with SPM. 78 case reports were included. The mean of age of the cases was 60.2 years. 60% were male. 95.4% were NENs G1. 17 cases of NENs had metastasis. 80% of SPM were recognized in the GIT (36% in stomach, 27% in large intestine, 11.2% in small intestine, and 5.6% in esophagus). The most common type of SPM was adenocarcinoma (49.4%), followed by GIST (13.5%), other NENs in different GIT segment (7.9%), lymphoma (6.8%), and squamous cell carcinoma (4.5%). The most common tumor in GIT was adenocarcinoma (97.6%) and the presence of adenocarcinoma in the same segment of GIT was found in 68.4% of the cases. Association between adenocarcinomas and NENs in GIT (p:<0.0001) and adenocarcinoma and tumor in the same segment of GIT location were observed (p<0.001).

CONCLUSION

These results demonstrate that NENs with SPM are not a rare condition. Several theories have been proposed to explain this association; one of these is the ability of NENs to generate synchronous tumors by autocrine and paracrine effect. We observed an association between adenocarcinomas and NENs in the same segment of GIT.

The Significant Influence of the Neuroendocrine Component on the Survival of Patients with Gastric Carcinoma Characterized by Coexisting Exocrine and Neuroendocrine Components

Background

Gastric adenocarcinoma patients with a neuroendocrine (NE) component are frequently observed in routine practice. Several previous studies have investigated the influence of a NE component on the survival of these patients; however, the results were inconsistent.

Methods

We retrospectively investigated a consecutive series of 95 gastric adenocarcinoma patients with a NE component and 190 gastric adenocarcinoma patients without a NE component. We adopted 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, and 90% as the cut-off proportions of the NE component, respectively, and analyzed the patients' overall survival according to the proportion of the NE component.

Results

The 1-, 3-, and 5-year actual survival rates of the patients with a NE component were 90.1%, 72.3%, and 67.2%, respectively, and for those without a NE component 94.2%, 79.3%, and 75.7%, respectively. The multivariate analysis showed that the patients with NE components >70% (HR: 2.156; 95% CI: 1.011, 4.597; p=0.047) and >90% (HR: 2.476; 95% CI: 1.088, 5.634; p=0.031) had significantly worse survival than those without a NE component. Only the diameter of tumors (>4.64 cm) (HR: 2.585; 95% CI: 1.112, 6.006; p=0.027) and pN3 (HR: 2.953; 95% CI: 1.051, 8.293; p=0.040) were independently associated with worse overall survival for gastric adenocarcinoma patients with a NE component (all p<0.05).

Conclusion

Gastric adenocarcinoma patients with a NE component >70% and >90% have significantly worse survival than those without a NE component. Only the diameter of tumors and the number of metastatic lymph nodes are independent prognostic factors for gastric adenocarcinoma patients with a NE component.

Gastric adenocarcinoma is concurrent with metastatic neuroendocrine cancer treated with nivolumab and chemotherapy: A case report

Gastric adenocarcinoma concurrent with metastatic neuroendocrine cancer (NEC) is rare. In the present case report, a 39-year-old male was first pathologically diagnosed by gastric endoscopy as having a highly differentiated adenocarcinoma. Next, positron emission tomography-computed tomography examination and bone marrow biopsy confirmed extensive metastasis. Subsequently, the patient underwent 6 cycles of immunotherapy (nivolumab, 160 mg) and 5 cycles of chemotherapy based on the XELOX regimen (oxaliplatin + capecitabine). Following this, the patient received the final cycles of nivolumab and XELOX; however, the patient then succumbed. Further biopsy of the metastatic collarbone lymph nodes indicated NEC. Overall, the progression-free survival was ~3.5 months, and overall survival (OS) was ~6 months. The case presented the possibility of concurrent gastric adenocarcinoma and NEC in the clinic. In addition, the efficacy of a combined regimen such as immunotherapy and chemotherapy for such disorders still requires further validation in the future.