1
|
Martí-Obiol R, Martí-Fernández R, Fernández-Moreno MC, Barrios-Carvajal ME, López-Mozos F. Characteristics of gastrointestinal stromal tumors associated to other tumors: Características de los tumores del estroma gastrointestinal asociados a otras neoplasias. Cir Esp 2024; 102:135-141. [PMID: 38135151 DOI: 10.1016/j.cireng.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Our aim is to analyze the differences between sporadic gastrointestinal stromal tumors and those associated with other tumors. METHODS Retrospective cohort study including patients with diagnosis of gastrointestinal stromal tumors operated at our center. Patients were divided into two groups, according to whether or not they had associated other tumors, both synchronously and metachronously. Disease free survival and overall survival were calculated for both groups. RESULTS 96 patients were included, 60 (62.5%) were male, with a median age of 66.8 (35-84). An association with other tumors was found in 33 cases (34.3%); 12 were synchronous (36.3%) and 21 metachronous (63.7%). The presence of mutations in associated tumors was 70% and in non-associated tumors 75%. Associated tumors were classified as low risk tumors based on Fletcher's stratification scale (p = 0.001) as they usually were smaller in size and had less than ≤5 mitosis per 50 HPF compared to non-associated tumors. When analyzing overall survival, there were statistically significant differences (p = 0,035) between both groups. CONCLUSION The relatively high proportion of gastrointestinal stromal tumors cases with associated tumors suggests the need to carry out a study to rule out presence of a second neoplasm and a long-term follow-up should be carried out in order to diagnose a possible second neoplasm. Gastrointestinal stromal tumors associated with other tumors have usually low risk of recurrence with a good long-term prognosis.
Collapse
Affiliation(s)
- Roberto Martí-Obiol
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain
| | - Rosa Martí-Fernández
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
| | | | | | - Fernando López-Mozos
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain; Department of Surgery, Universidad de Valencia, Valencia, Spain
| |
Collapse
|
2
|
Liu J, Huang BJ, Ding FF, Tang FT, Li YM. Synchronous occurrence of gastric cancer and gastrointestinal stromal tumor: A case report and review of the literature. World J Gastrointest Oncol 2023; 15:1807-1822. [PMID: 37969409 PMCID: PMC10631440 DOI: 10.4251/wjgo.v15.i10.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND To evaluate the clinicopathological features and prognosis of gastric cancer (GC) occurring synchronously with gastrointestinal stromal tumor (GIST). CASE SUMMARY We report 19 patients with concurrent GC and GIST (17 male and 2 female, median age 62 years). GC was most often located in the lower third of the stomach. GIST was diagnosed preoperatively in four patients. GIST was most often located in the gastric body (n = 8, 42%). The most common growth pattern in GIST was extraluminal (n = 12, 63%). The positive expression rates of CD117 and CD34 in GIST were 100% and 95%, respectively. Most patients with GIST (n = 17, 89%) were very low or low risk. There was no recurrence of GIST during follow-up. The 3-year cumulative survival rate was 73.9%, and the 5-year cumulative survival rate was 59.2%. The combined analysis of this study and literature reports (47 reports, 157 patients) found that GC and GIST were usually located in the lower third (42%) and middle third (51%) of the stomach. GC was usually early (stage I: 42%), poorly differentiated (42%) intestinal-type adenocarcinoma (51%). GISTs were primarily small in diameter (median: 1.2 cm) and very low or low risk (89%). CONCLUSION Synchronous GC and GIST may not be rare. They have specific clinicopathological characteristics, and may have mutual inhibition in pathogenesis and progression.
Collapse
Affiliation(s)
- Jie Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Bin-Jie Huang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fei-Fei Ding
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fu-Tian Tang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Yu-Min Li
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| |
Collapse
|
3
|
Fukuda H, Sakurai Y, Nomoto Y, Nakamura Y, Karaki H, Okaya T, Hirai F, Abe M, Sugano I. Gastric collision tumor composed of early-stage gastric carcinoma and gastrointestinal stromal tumor: a case report. Clin J Gastroenterol 2022; 15:1055-1060. [DOI: 10.1007/s12328-022-01708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
|
4
|
Ramos MFKP, Pereira MA, Dias AR, de Mello ES, Almeida JL, Zilberstein B, Ribeiro-Júnior U, Cecconello I. Gastric Remnant Carcinosarcoma: Case Report and Review of the Literature. J Gastrointest Cancer 2021; 52:336-341. [PMID: 32607961 DOI: 10.1007/s12029-020-00447-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil.
| | - Marina Alessandra Pereira
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Andre Roncon Dias
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Evandro Sobroza de Mello
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Jose Luiz Almeida
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Bruno Zilberstein
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Ulysses Ribeiro-Júnior
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Ivan Cecconello
- Cancer Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| |
Collapse
|
5
|
Matsuno K, Kanazawa Y, Kakinuma D, Hagiwara N, Ando F, Masuda Y, Fujita I, Arai H, Nomura T, Kato S, Yoshiyuki T, Peng WX, Yoshida H. Preoperatively diagnosed gastric collision tumor with mixed adenocarcinoma and gastrointestinal stromal tumor: a case report and literature review. Clin J Gastroenterol 2021; 14:494-499. [PMID: 33512639 PMCID: PMC8016778 DOI: 10.1007/s12328-021-01343-4] [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] [Received: 05/15/2020] [Accepted: 01/08/2021] [Indexed: 11/12/2022]
Abstract
Reports of gastric collision tumors, comprising adenocarcinoma and gastrointestinal stromal tumor, are extremely rare. Here, we report the case of a 68-year-old male who was diagnosed with a lower-body, moderately differentiated, tubular-type adenocarcinoma and submucosal tumor and underwent an elective D2 distal gastrectomy. The tumor cells of the gastrointestinal stromal tumor were positive for H-caldesmon and CD117, weakly positive for smooth muscle actin and DOG-1, and negative for desmin, S-100 protein, CD31, and AE1/AE3. The tumor had grown into a mixed form of adenocarcinoma and gastrointestinal stromal tumor. Thus, we report the first case of a preoperatively diagnosed collision tumor in the stomach consisting of adenocarcinoma and gastrointestinal stromal tumor.
Collapse
Affiliation(s)
- Kunihiko Matsuno
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yoshikazu Kanazawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Daisuke Kakinuma
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Fumihiko Ando
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuka Masuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Itsuo Fujita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroki Arai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tsutomu Nomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shunji Kato
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Toshiro Yoshiyuki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Wei-Xia Peng
- Department of Integrated Diagnostic Pathology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| |
Collapse
|
6
|
Das P, Panigrahi R, Pradhan P, Senapati U, Mohapatra MK. Pancreatic collision tumor of ductal adenocarcinoma and neuroendocrine tumor-A rare case report. INDIAN J PATHOL MICR 2021; 64:S172-S174. [PMID: 34135163 DOI: 10.4103/ijpm.ijpm_735_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A collision tumor is composed of two adjacent histological distinct neoplasms without the histological admixture of cell types in the same organ or tissue. It is rare in pancreas. Herein we report an unusual case of a mixed malignant neuroendocrine tumor (NET) and ductal adenocarcinoma of pancreas in a 24 year old male who presented with history abdomen pain. A clinicoradiological diagnosis of chronic calcific pancreatitis with carcinoma body of pancreas was made. Distal pancreaticosplenectomy specimen showed a grey white, nodular growth measuring 2 x 2 x 1.2 cm on the cut surface of pancreas. Histopathology revealed a composite tumor consisting of ductal and neuroendocrine origin. Immunohistochemistry showed complementary staining for CK7 in adenocarcinoma and chromogranin A in NET areas confirming a collision tumor. Accurate evaluation of the radiologic pointers, histomorphologic evaluation to recognize and quantitate the individual components, appropriate immunohistochemical evaluation and correlation is essential for diagnosis.
Collapse
Affiliation(s)
- Prajna Das
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ranjita Panigrahi
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prita Pradhan
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Urmila Senapati
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mihir Kumar Mohapatra
- Department of Surgical Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
7
|
Diamantis A, Samara AA, Symeonidis D, Baloyiannis I, Vasdeki D, Tolia M, Volakakis G, Mavrovounis G, Tepetes K. Gastrointestinal stromal tumors (GISTs) and synchronous intra-abdominal malignancies: case series of a single institution's experience. Oncotarget 2020; 11:4813-4821. [PMID: 33447349 PMCID: PMC7779251 DOI: 10.18632/oncotarget.27853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Gastrointestinal stromal tumors (GISTs) quite often co-exist with other primary tumors, as seen in up to 33% of cases. In the literature such occurrences have primarily been described through case reports and rarely through case series, which is not sufficient to prove if there is an association between these two entities. Materials and Methods: We conducted a retrospective study using medical and pathological records from sixty-nine patients who underwent surgical treatment for GIST in a single university surgical department between 2011 and 2019. Seven cases of GIST accompanying a synchronous primary tumor were identified and included in the study. Results: Survival analysis comparing the overall survival of patients with single GIST versus patients with concurrent GIST and another primary tumor, has shown no statistically significant difference between these two groups (p = 0.19). However, when comparing the recurrence rate, patients with synchronous GISTs and another primary tumor have a statistically significant increased possibility for recurrence (p = 0.02). Statistical analysis comparing the size of GISTs between the two groups has shown that patients with single GIST have larger tumors than patients with synchronous tumors (p = 0.048). Conclusions: The synchronous occurrence of GISTs and other intra-abdominal tumors is more common than previously considered, though it is not yet clear if there is a causal association for the concomitant occurrence. Further studies are required to elucidate the genetic and molecular mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.
Collapse
Affiliation(s)
- Alexandros Diamantis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Athina A Samara
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Dimitrios Symeonidis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Dionysia Vasdeki
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Georgios Volakakis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Georgios Mavrovounis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece.,Faculty of Medicine, University of Thessaly, Mezourlo, Larissa, Greece
| | - Konstantinos Tepetes
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| |
Collapse
|
8
|
Trihia HJ. Coexistence of Gastric Cancer and Multiple Small Gastrointestinal Stromal Tumors: Report of a Unique Case and Review of the Literature. Gastrointest Tumors 2018; 5:63-67. [PMID: 30976576 DOI: 10.1159/000495178] [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: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 11/19/2022] Open
Abstract
Background In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. The simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) has been documented rarely. Summary The coexistence of primary gastric adenocarcinoma and GIST has been detected incidentally on gastric mucosa, serosa or occasionally intramurally, at surgery, or gastroscopy for other reasons. We present a case of a 79-year-old male patient who underwent surgery for an advanced gastric carcinoma, where multiple nodules of GIST were incidentally discovered during the work-up of his gastrectomy specimen. Key Message GISTs range from small "low-risk" tumors to sarcomas. Small GISTs are found incidentally during unrelated surgery or autopsy. Multiple GISTs are extremely rare and usually associated with hereditary diseases. Practical Implications In any case of gastrointestinal neoplasm, the surgeon and pathologist should be alert to perform a thorough investigation. Our case could provide further awareness and insight into the entity of concurrent tumors.
Collapse
Affiliation(s)
- Helen J Trihia
- Department of Pathology, "Metaxas" Cancer Hospital, Piraeus, Greece
| |
Collapse
|
9
|
Liu S, Liu H, Dong Y, Wang F, Wang H, Chen J. Gastric carcinoma with a gastrointestinal stromal tumor - A case report and literature review. Med Sci (Paris) 2018; 34 Focus issue F1:15-19. [PMID: 30403169 DOI: 10.1051/medsci/201834f103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gastric carcinoma (GC) with gastrointestinal stromal tumor (GIST) is encountered very rarely in the clinic, and few cases have been reported in the literature. Here, we present a case involving a 72-year-old man who was diagnosed with gastric antrum adenocarcinoma accompanied by neuroendocrine differentiation and a GIST in the fundus, according to a preoperative examination and postoperative pathology. The patient then underwent a distal radical gastrectomy and GIST resection. After the operation, the patient was administered combined chemo-radiotherapy and subsequently underwent a 9-month follow-up examination. The gene mutations involved in this case were explored via high-throughput sequencing. The high-throughput gene mutation analysis indicated an exon5 mutation in the TP53 gene and copy number amplification of FGF19, CCND1, and FGFR2 in the gastric antrum adenocarcinoma. A gene sequencing analysis of the gastric fundus stromal tumor demonstrated an exon11 non-frame shift deletion mutation in the KIT gene. These findings suggested that this patient's cancer might be sensitive to AZD1775 (a TP53-targeted drug) or targeted drugs such as FGF19, CCND1 and FGFR2, and should be sensitive to imatinib.
Collapse
Affiliation(s)
- Sen Liu
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute
| | - Yunlong Dong
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute
| | - Fengbiao Wang
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Huijuan Wang
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Jun Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute - Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, China
| |
Collapse
|
10
|
Primary Central Nervous System Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Colliding with Meningioma. World Neurosurg 2018; 120:17-26. [PMID: 30144614 DOI: 10.1016/j.wneu.2018.08.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Collision tumors are defined as coexistence of 2 histologically different neoplasms occurring in the same anatomic location. Such co-occurrence of tumors in the brain is uncommon. To our knowledge, meningioma colliding with extranodal natural killer/T-cell lymphoma has not been described previously. CASE DESCRIPTION A 50-year-old man presented with a 1-year history of progressive memory decline and 2 weeks of drowsiness, bradykinesia, and aphasia. Magnetic resonance imaging revealed a heterogeneously enhanced mass beside the left frontal cerebral falx resulting in midline shift. The left frontal lobe mass was resected. Pathologic examination showed the tumor consisted of whorled spindle cells and diffuse medium-sized lymphoid cells. The spindle cells were positive for epithelial membrane antigen and negative for S-100. The lymphoid cells expressed CD3ε, CD56, TIA-1, and granzyme B. Epstein-Barr virus encoded small RNAs were detected by in situ hybridization. No monoclonal T-cell receptor gamma gene rearrangement was detected. Four weeks after surgery, the patient was treated with polychemotherapy and intrathecal methotrexate, but he died 2 months later. CONCLUSIONS This is the first report of a unique brain collision tumor consisting of a meningioma and an extranodal natural killer/T-cell lymphoma. Diagnosis depends on histopathology. Awareness of this entity is important to distinguish it from other intracranial tumors.
Collapse
|
11
|
Pancreatic Collision Tumor of Ductal Adenocarcinoma and Neuroendocrine Tumor. ACG Case Rep J 2018; 5:e39. [PMID: 29850646 PMCID: PMC5968152 DOI: 10.14309/crj.2018.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/28/2018] [Indexed: 01/13/2023] Open
Abstract
A pancreatic collision tumor is a rare entity that can be challenging to diagnose. We present a very rare case of a pancreatic collision tumor composed of both a neuroendocrine tumor and a ductal adenocarcinoma. Preoperative diagnosis was clinically challenging because both the radiology and fine-needle biopsy were consistent with a typical neuroendocrine mass. However, gross examination of the mass postoperatively revealed neuroendocrine cells with rare foci of ductal adenocarcinoma without a transition zone. Awareness of this entity is important so that medical practitioners consider pursuing surgical management of pancreatic lesions that otherwise would be managed exclusively with surveillance.
Collapse
|
12
|
Kuroda H, Saito H, Kono Y, Murakami Y, Shishido Y, Matsunaga T, Fukumoto Y, Osaki T, Ashida K, Nosaka K, Umekita Y, Fujiwara Y. Carcinosarcoma of Stomach Confined to the Mucosa. Yonago Acta Med 2018; 60:246-250. [PMID: 29434495 DOI: 10.24563/yam.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023]
Abstract
Carcinosarcoma is a malignant tumor composed of both epithelial and mesenchymal malignant tumor components. A 78-year-old man was transferred to our hospital because of hematemesis and tarry stool. An emergency gastrointestinal endoscopic examination revealed active bleeding from an ulcerative lesion on the posterior wall of the gastric body; endoscopic hemostasis was successfully performed. A gastrointestinal endoscopy performed two months later showed a polypoid lesion at the same place where the ulcer had been. The biopsy specimen was histologically diagnosed as well to moderately differentiated tubular adenocarcinoma. The patient underwent a laparoscopic distal gastrectomy with D2 lymph node dissection under a diagnosis of gastric adenocarcinoma. A 28 × 15 mm polypoid tumor was resected from the gastric body, and was found on microscopic examination to consist of both carcinoma and sarcoma components, showing atypical spindle cells, which were positive for α-smooth muscular actin, calponin, and h-caldesmon, but negative for CD34, CD117 (c-kit), desmin, and dog 1. These findings led to a diagnosis of gastric carcinosarcoma. The tumor was confined to the mucous membrane. Lymph node metastasis was found in one node and contained only the carcinoma component. The postoperative course was uneventful. The patient lived without recurrence for 2 years. Carcinosarcoma of the stomach is a rare tumor with high malignant potential and poor prognosis. Careful follow up is required for early detection of any recurrence.
Collapse
Affiliation(s)
- Hirohiko Kuroda
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hiroaki Saito
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yusuke Kono
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuki Murakami
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoji Fukumoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomohiro Osaki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Keigo Ashida
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kanae Nosaka
- †Division of Organ Pathology, Department of Pathology, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshihisa Umekita
- †Division of Organ Pathology, Department of Pathology, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| |
Collapse
|
13
|
Miyamoto R, Kikuchi K, Uchida A, Ozawa M, Kemmochi A, Sano N, Tadano S, Inagawa S, Adachi S, Yamamoto M. Collision tumor consisting of a colorectal adenocarcinoma and dissemination of a gastric adenocarcinoma. SAGE Open Med Case Rep 2018; 6:2050313X17751839. [PMID: 29326826 PMCID: PMC5758956 DOI: 10.1177/2050313x17751839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/12/2017] [Indexed: 01/16/2023] Open
Abstract
Background: Collision tumors, composed of histologically distinct tumor types, are rare entities, especially in the colorectum, and corresponding evidence-based clinical management or treatment strategies are poorly defined. This is the first report of a collision tumor composed of two histologically distinct adenocarcinomas. Case presentation: A 78-year-old male showed severe anemia and a 10% body weight loss over 1 month. Preoperative examination revealed T3N1M0 stage IIIA gastric cancer and T3N0M0 stage IIA rectal cancer. Distal gastrectomy and rectectomy with regional lymph node dissection were performed. Immunohistochemistry revealed two distinct adenocarcinomas with gland duct structures – a colorectal adenocarcinoma and a disseminated gastric adenocarcinoma – that had collided to form an invasive tumor on the serosal surface of the anterior rectum wall. Conclusion: This extremely rare case of a collision tumor supports that precise immunohistochemical identification of all tumor components is needed for guiding decisions affecting overall prognosis, adjuvant treatment and survival.
Collapse
Affiliation(s)
- Ryoichi Miyamoto
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazunori Kikuchi
- Department of Pathology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Atsushi Uchida
- Department of Pathology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masayoshi Ozawa
- Department of Pathology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Akira Kemmochi
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Naoki Sano
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Sosuke Tadano
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Satoshi Inagawa
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Shinya Adachi
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masayoshi Yamamoto
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| |
Collapse
|
14
|
Clinicopathological and molecular characteristics of synchronous gastric adenocarcinoma and gastrointestinal stromal tumors. Sci Rep 2017; 7:12890. [PMID: 29018259 PMCID: PMC5635104 DOI: 10.1038/s41598-017-12622-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 08/16/2017] [Indexed: 12/29/2022] Open
Abstract
Synchronous gastric tumors that consist of both gastrointestinal stromal tumor (GIST) and adenocarcinoma are rare. We studied the clinicopathological and molecular characteristics of six cases containing both gastric adenocarcinoma and GIST. By means of immunohistochemical analysis, all GIST cells expressed CD117, CD34 and Dog1 in all six synchronous gastric adenocarcinomas with GIST, and in GIST alone. Sequencing analysis demonstrated that exon 11 c-kit mutations were present in two of six synchronous tumors and four of five GISTs. One of the two exon 11 c-kit mutations in synchronous adenocarcinomas with GISTs was an uncommon mutation of CTT > CCA at amino acid 576, and the other was a GTT deletion at amino acid 560. The mutation was a homozygous A > G mutation in exon 12 (amino acid 567) of PDGFR-α. We concluded that the exon 11 mutations were the most important in both cases of synchronous gastric adenocarcinoma with GIST and GIST alone. The mutation rate was higher in GIST alone than in synchronous adenocarcinoma with GIST.
Collapse
|
15
|
Kuroda H, Saito H, Kono Y, Murakami Y, Shishido Y, Matsunaga T, Fukumoto Y, Osaki T, Ashida K, Nosaka K, Umekita Y, Fujiwara Y. Carcinosarcoma of Stomach Confined to the Mucosa. Yonago Acta Med 2017. [DOI: 10.33160/yam.2017.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Hirohiko Kuroda
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hiroaki Saito
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yusuke Kono
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuki Murakami
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoji Fukumoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomohiro Osaki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | | | - Kanae Nosaka
- Division of Organ Pathology, Department of Pathology, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshihisa Umekita
- Division of Organ Pathology, Department of Pathology, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| |
Collapse
|
16
|
Synchronous occurrence of gastrointestinal stromal tumors and other digestive tract malignancies in the elderly. Oncotarget 2016; 6:8397-406. [PMID: 25826075 PMCID: PMC4480761 DOI: 10.18632/oncotarget.3108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/08/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Elderly patients with gastrointestinal stromal tumors (GISTs) synchronous with other digestive tract malignancies have been rarely reported. In this study, clinicopathological characteristics were evaluated among elderly patients with GISTs with or without coexisting digestive tract malignancies. METHODS A total of 161 patients (≥65 years) were retrospectively reviewed at the West China Hospital, Sichuan University from January 2009 to June 2014. RESULTS Sixty-one patients were diagnosed with synchronous digestive tract malignancies (synchronous group), whereas 100 patients were diagnosed with no synchronous condition (no-synchronous group). The synchronous group exhibited a higher percentage of males (70.49% vs. 53.00%, P = 0.028) and poorer Eastern Cooperative Oncology Group performance status than the no-synchronous group (P = 0.029). The three-year overall survival (OS) rate was significantly lower among patients with synchronous digestive tract malignancies than that among patients without synchronous condition (64.5% vs. 84.0%, P = 0.003). Multivariate analysis showed that the presence of synchronous digestive tract malignancies (P = 0.002), co-morbidity (P = 0.004), and mitotic count ≥10 mitoses/50 high power fields (P = 0.012) were associated with poor OS. CONCLUSIONS A synchronous condition with other digestive tract malignancies is common in elderly patients with GISTs. OS primarily depends on synchronous digestive tract malignancies, mitotic count, and co-morbidity.
Collapse
|
17
|
Gao NA, Guo NJ, Yu WZ, Wang XX, Sun JR, Yu N, Liu RT, Liu XD, Liu ZY, Feng R. Synchronous occurrence of gastrointestinal stromal tumor and acute myeloid leukemia: A case report and review of the literature. Oncol Lett 2016; 11:2977-2980. [PMID: 27123049 PMCID: PMC4840780 DOI: 10.3892/ol.2016.4353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 12/04/2015] [Indexed: 01/11/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) originate from the mesenchymal tissue of the gastrointestinal tract. The pathogenesis of GIST is associated with the mutational activation of the receptor tyrosine kinase cluster of differentiation (CD)117 or platelet-derived growth factor receptor-α. Overall, ~60% of GISTs occur in the stomach. Clinically, GISTs may coexist with various types of cancer, including liver cancer, pancreatic tumors and lymphoma, either synchronously or metachronously. The present study reports the case of a patient with the synchronous occurrence of a CD117-positive GIST and acute myeloid leukemia. A 69-year-old man was hospitalized for heart palpitations and dizziness, and was diagnosed with acute myeloid leukemia (AML) by bone marrow aspiration and flow cytometry analysis. An abdominal computed tomograpy and gastroscopy revealed the presence of GIST. The patient received chemotherapy in combination with imatinib (400 mg/day), and the mass was removed 2 months later. To the best of our knowledge, the present study is the first reported case of the synchronous development of a CD117-positive GIST and AML. Additional studies are required in order to understand the association between GIST and hematological malignancies.
Collapse
Affiliation(s)
- N A Gao
- Department of Hematology, Central Hospital of Jinan, Shandong University School of Medicine, Jinan, Shandong 250013, P.R. China; Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Nong-Jian Guo
- Department of Hematology, Central Hospital of Jinan, Shandong University School of Medicine, Jinan, Shandong 250013, P.R. China
| | - Wen-Zheng Yu
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Xue-Xia Wang
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Jian-Rong Sun
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Ning Yu
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Ren-Tong Liu
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Xiao-Dan Liu
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Zeng-Yan Liu
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Rui Feng
- Department of Hematology, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| |
Collapse
|
18
|
Telugu RB, Pushparaj M, Masih D, Pulimood A. Synchronous Appearance of Adenocarcinoma and Gastrointestinal Stromal Tumour (GIST) of the Stomach: A Case Report. J Clin Diagn Res 2016; 10:ED16-8. [PMID: 27042477 DOI: 10.7860/jcdr/2016/17636.7289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/11/2015] [Indexed: 12/23/2022]
Abstract
Adenocarcinoma is the most common histological type of gastric tumour, accounting for approximately 95% of all gastric carcinomas. Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the digestive tract. Synchronous adenocarcinoma and gastrointestinal stromal tumour (GIST) occurring in the stomach is rare and very few cases have been reported in literature. Synchronous tumours in the stomach are rarely diagnosed preoperatively. A 63-year-old gentleman was diagnosed with a gastric adenocarcinoma on endoscopic biopsy and underwent surgery. Postoperative histopathologic examination revealed 2 synchronous tumours with both adenocarcinoma and GIST. The adenocarcinoma was determined to be the aggressive tumour based on histologic features. GIST was categorized as a very low risk of malignancy, based on its size and mitosis. The patient underwent chemotherapy for adenocarcinoma. He is under follow up and is currently disease free. Careful histopathologic evaluation is required to detect co-existing rare synchronous tumours. Presence of the second tumour may require additional procedures or protocols.
Collapse
Affiliation(s)
- Ramesh Babu Telugu
- Assistant Professor, Department of General Pathology, Christian Medical College , Vellore, Tamilnadu, India
| | - Magesh Pushparaj
- PG Registrar, Department of General Pathology, Christian Medical College , Vellore, Tamilnadu, India
| | - Dipti Masih
- Associate Professor, Department of General Pathology, Christian Medical College , Vellore, Tamilnadu, India
| | - Anna Pulimood
- Professor, Department of General Pathology, Christian Medical College , Vellore, Tamilnadu, India
| |
Collapse
|
19
|
Goyal R, Parwani AV, Gellert L, Hameed O, Giannico GA. A collision tumor of papillary renal cell carcinoma and oncocytoma: case report and literature review. Am J Clin Pathol 2015; 144:811-6. [PMID: 26486747 DOI: 10.1309/ajcpq0p1yhdbzufl] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The most common renal neoplasms include clear cell, chromophobe, and papillary renal cell carcinomas (PRCCs) and oncocytomas. While lesions containing hybrid features of different tumor types, such as hybrid oncocytic tumors, have been well documented in the literature, the finding of a collision tumor of two distinct tumor types- PRCC and oncocytoma-is extremely rare. METHODS We present a case of PRCC associated with an oncocytoma. Our discussion includes a review of the available literature on this rare type of collision tumor. RESULTS Prosection of a partial nephrectomy performed in a 78-year-old man for painless gross hematuria and nocturia revealed a 6.4 × 5 × 3.6-cm well-delineated orange to yellow-tan mass harboring a white-tan 1 × 0.9 × 0.9-cm mass. Histologic diagnosis of PRCC associated with an oncocytoma was rendered. By immunohistochemistry, focal CK7 expression was present in the oncocytoma, while strong diffuse positive CK7 expression was present in the PRCC component. Fluorescence in situ hybridization (FISH) revealed trisomy 17 in 39.3% of PRCC tumor nuclei but no significant chromosomal aberration in oncocytoma. CONCLUSIONS In view of this and previously reported cases, thorough sectioning and examination, especially in large oncocytomas, is recommended to exclude the presence of an associated malignancy. To our knowledge, trisomy 17 by FISH has not been previously reported in these extremely rare tumors.
Collapse
|
20
|
Shin HC, Gu MJ, Kim SW, Kim JW, Choi JH. Coexistence of gastrointestinal stromal tumor and inflammatory myofibroblastic tumor of the stomach presenting as a collision tumor: first case report and literature review. Diagn Pathol 2015; 10:181. [PMID: 26445324 PMCID: PMC4596292 DOI: 10.1186/s13000-015-0413-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Collision tumors of the stomach are rare. We report on a case of a collision tumor consisting of a gastrointestinal stromal tumor (GIST) and an inflammatory myofibroblastic tumor (IMT) of the stomach in a 16-year-old female. A polypoid mass located in the distal body of the stomach was observed on abdominal computed tomography. Laparoscopic wedge resection of the stomach and 4d lymph node biopsy was performed. On gross examination, a protruding submucosal mass, measuring 4 × 3.5 × 2.5 cm in size, was detected. Histological examination showed two distinct GIST and IMT component presenting a collision tumor. The small nodular area, composed of CD117-positive spindle cells, was typical of GIST, and the adjacent larger area, composed of myofibroblastic spindle cells with prominent chronic inflammatory cells infiltrate, mainly lymphocytes and plasma cells, had a characteristic appearance of IMT. The 4d lymph node showed metastatic inflammatory myofibroblastic tumor. To the best of our knowledge, this is the first case of a collision tumor consisting of a GIST and an IMT arising in the stomach.
Collapse
Affiliation(s)
- Hyeong Chan Shin
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu City, 705-703, South Korea.
| | - Mi Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu City, 705-703, South Korea.
| | - Se Won Kim
- Department of Sugery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu City, 705-703, South Korea.
| | - Jae Woon Kim
- Department of Radiology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu City, 705-703, South Korea.
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu City, 705-703, South Korea.
| |
Collapse
|
21
|
Shi Z, Zhuang Q. Computed tomography imaging characteristics of synchronous gastrointestinal stromal tumors in patients with gastric cancer and correlation with clinicopathological findings. Mol Clin Oncol 2015; 3:1311-1314. [PMID: 26807239 DOI: 10.3892/mco.2015.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/27/2015] [Indexed: 11/05/2022] Open
Abstract
This study was conducted to analyze the computed tomography (CT) imaging and clinicopathological characteristics of synchronous gastrointestinal stromal tumors (GISTs) in patients with gastric cancer. We retrospectively reviewed the CT images in 18 cases of immunohistochemically confirmed synchronous GISTs in patients with primary gastric cancer. Relevant histology and clinical data were also obtained. Multi-slice CT (MSCT) identified suspected synchronous GISTs in 26 patients, of which 18 were finally confirmed. Of the 18 patients, 12 were male and 6 female, with a mean age of 69.2 years. All 18 lesions were discovered as a solitary mass, ranging in size from 1.0 to 6.5 cm (mean, 2.2 cm). The lesions were predominantly located in the gastric fundus and were characterized by an ovoid shape, well-defined margins and isodensity, with slight to moderate gradual enhancement on MSCT. There was no evidence of necrosis, hemorrhage or cystic degeneration, irrespective of the tumor size. Synchronous GISTs exhibited spindle cell morphological characteristics and specific immunohistochemical properties, and were classified as being of low or very low malignant potential. In conclusion, since gastric cancer patients with a synchronous GIST are rare, a solitary, ovoid and well-defined mass with slight to moderate gradual enhancement following contrast agent injection may be suggestive of this diagnosis, although detection of synchronous GISTs does not appear to significantly affect therapy and outcome.
Collapse
Affiliation(s)
- Zhenshan Shi
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, P.R. China
| | - Qian Zhuang
- Department of Pharmacy, Union Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| |
Collapse
|
22
|
Gastric collision tumors: an insight into their origin and clinical significance. Gastroenterol Res Pract 2015; 2015:314158. [PMID: 25767509 PMCID: PMC4342179 DOI: 10.1155/2015/314158] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/19/2022] Open
Abstract
Collision tumors are rare neoplasms displaying two distinct cell populations developing in juxtaposition to one another without areas of intermingling. They are rare entities with only 63 cases described in English literature. Tumors encountered are gastric adenocarcinomas colliding with lymphomas, gastrointestinal stromal tumors, squamous cell carcinomas, and neuroendocrine tumors. Their cell origin is obsolete by the time of diagnosis. Different tumorigenesis theories have been suggested to explain their behavior, yet none has managed to provide satisfactory explanation for all cases. Clinically they are indistinguishable from the dominant tumor. Lack of data does not allow detailed assessment of their behavior yet they seem aggressive neoplasms with dismal prognosis. The majority of cases have been diagnosed postoperatively during histologic examination of specimens. There are no guidelines or concrete evidence to support best way of adjuvant or other types of treatment. However, these rare neoplasms might help in unlocking secrets of cancer behavior including tumorigenesis, differentiation, and adhesion and thus clinicians should be aware of their existence.
Collapse
|
23
|
Lee JH, Kim HW, Kang DH, Choi CW, Park SB, Kim SH. A gastric composite tumor with an adenocarcinoma and a neuroendocrine carcinoma: a case report. Clin Endosc 2013; 46:280-3. [PMID: 23767040 PMCID: PMC3678067 DOI: 10.5946/ce.2013.46.3.280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/18/2012] [Accepted: 07/12/2012] [Indexed: 12/14/2022] Open
Abstract
A 70-year-old woman was admitted to our department with epigastric discomfort and nausea over the duration of 1 month. An esophagogastroduodenoscopy showed the presence of a 1.0×1.0 cm-sized flat lesion with central ulceration at the greater curvature side of the antrum. A biopsy demonstrated the presence of an adenocarcinoma of well differentiated, intestinal type in the stomach. Endoscopic submucosal dissection was done and the diagnosis of a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach was confirmed. We report a case of a gastric composite tumor with an adenocarcinoma and neuroendocrine carcinoma confirmed by endoscopic submucosal dissection with a review of the literature.
Collapse
Affiliation(s)
- Jae Hyung Lee
- Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | | | | | | | | | | |
Collapse
|
24
|
Cai R, Ren G, Wang DB. Synchronous adenocarcinoma and gastrointestinal stromal tumors in the stomach. World J Gastroenterol 2013; 19:3117-3123. [PMID: 23716992 PMCID: PMC3662952 DOI: 10.3748/wjg.v19.i20.3117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/28/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the clinicopathological characteristics of concurrent gastrointestinal stromal tumors (GISTs) and gastric adenocarcinoma.
METHODS: We retrospectively analyzed eight cases of synchronous adenocarcinoma and GIST in the stomach that had been surgically resected with curative intent between March 2003 and December 2008 in Xinhua hospital and Ruijin hospital. The adenocarcinoma was determined to be the primary tumor based on the histological features. The GIST cells were diffusely and strongly positive for CD34 and CD117.
RESULTS: The patients were six men and two women aged 47-80 years (average, 68.6 years). GIST was preoperatively detected in only one patient. The average sizes of the gastric adenocarcinomas and GISTs were 6.000 ± 2.6186 cm and 1.825 ± 1.4370 cm, respectively. All GISTs were very low- or low-risk lesions that were detected during evaluation, staging, operation or follow-up for gastric adenocarcinoma.
CONCLUSION: We hypothesized that the stomach was influenced by the same unknown carcinogen, resulting in a simultaneous proliferation of different cell lines (epithelial and stromal cell).
Collapse
|
25
|
Bhattacharya A, Saha R, Biswas J, Biswas J, Ghosh B. Collision tumors in the gastrointestinal tract: a rare case series. Int Med Case Rep J 2012; 5:73-7. [PMID: 23754928 PMCID: PMC3658259 DOI: 10.2147/imcrj.s35818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A collision tumor is one where histology shows the presence of two distinct primaries involving the same organ without intermixture of individual cell types, ie, a side by side pattern. Here we present three rare cases of collision tumors involving the stomach and transverse colon. There were two cases of collision tumors involving the stomach, one of which was a combination of adenocarcinoma and low-grade non-Hodgkin’s (mucosa-associated lymphoid tissue) lymphoma, and the other showed the presence of non-Hodgkin’s lymphoma involving the entire stomach wall along with adenocarcinoma infiltrating the muscle layer. The third case comprised a mucinous adenocarcinoma and carcinoid tumor in the large gut.
Collapse
|
26
|
Abstract
Gastrointestinal stromal tumor has received a lot of attention over the last 10 years due to its unique biologic behavior, clinicopathological features, molecular mechanisms, and treatment implications. GIST is the most common mesenchymal neoplasm in the gastrointestinal tract and has emerged from a poorly understood and treatment resistant neoplasm to a well-defined tumor entity since the discovery of particular molecular abnormalities, KIT and PDGFRA gene mutations. The understanding of GIST biology at the molecular level promised the development of novel treatment modalities. Diagnosis of GIST depends on the integrity of histology, immunohistochemistry and molecular analysis. The risk assessment of the tumor behavior relies heavily on pathological evaluation and significantly impacts clinical management. In this review, historic review, epidemiology, pathogenesis and genetics, diagnosis, role of molecular analysis, prognostic factor and treatment strategies have been discussed.
Collapse
|
27
|
Go JH. Collision of adenocarcinoma and schwannoma of the stomach: a case report. KOREAN JOURNAL OF PATHOLOGY 2012; 46:373-6. [PMID: 23110031 PMCID: PMC3479830 DOI: 10.4132/koreanjpathol.2012.46.4.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/29/2011] [Accepted: 07/04/2011] [Indexed: 01/17/2023]
Abstract
The simultaneous occurrence of an adenocarcinoma and schwannoma is extremely rare in the stomach, and only one such case has been previously reported, which presented as two separate masses. Indeed, the collision of these tumors has never been reported. We report the case of a 61-year-old male patient who was diagnosed with the synchronous development of a schwannoma and advanced mucinous adenocarcinoma of the stomach, in which the carcinoma cells focally invaded the schwannoma.
Collapse
Affiliation(s)
- Jai Hyang Go
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
28
|
Yoshida H, Tanaka N, Tochigi N, Suzuki Y. Rapidly deforming gastric carcinosarcoma with osteoblastic component: An autopsy case report. World J Gastroenterol 2012; 18:4064-8. [PMID: 22912559 PMCID: PMC3420005 DOI: 10.3748/wjg.v18.i30.4064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/11/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Carcinosarcomas are rare, malignant, biphasic tumors simultaneously comprising carcinoma and sarcoma in a single tumor. We present an extremely rare case of gastric carcinosarcoma with an osteoblastic component that drastically changed its shape within 2 mo. A 59-year-old male patient presented to the emergency outpatient unit with a complaint of black stool. Gastrointestinal endoscopy showed an ulcerated mass in the cardia of the lesser curvature of the stomach. Biopsy specimens revealed only adenocarcinoma. Two months later, the ulcerated lesion drastically changed its shape into an exophytic tumor. Total gastrectomy was performed. In the resected specimen, the gastric tumor contained both adenocarcinoma and sarcoma components with lace-like osteoid. The patient died 7 mo after the operation, and an autopsy was performed. In the autopsy, widespread metastases were present in the liver, lung, lymph nodes and peritoneum. In this report, we describe a case of gastric carcinosarcoma and presume its tumorigenesis based on the autopsy findings.
Collapse
|
29
|
Selcukbiricik F, Tural D, Senel ET, Dervisoglu S, Serdengecti S. Gastric carcinoma with osteoblastic differentiation. Int J Surg Case Rep 2012; 3:516-9. [PMID: 22889705 DOI: 10.1016/j.ijscr.2012.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/04/2012] [Accepted: 07/06/2012] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Carcinosarcoma is a rare malignant biphasic tumor which has sarcomatous and carcinomatous components. Stomach localization is very rare. We discuss the diagnosis, follow-up and treatment of patients diagnosed with gastric carcinosarcoma in company with the literature review. PRESENTATION OF CASE A 73-year-old white male patient applied to hospital with dyspeptic complaints lasting for 2months. His endoscopic examination revealed an ulcero-vegetating mass in the cardiac region of his stomach. Total gastrectomy and D2 lymph node dissection were performed for the patient. In the pathologic evaluation, the tumor was found consistent with Stage IIA stomach adenocarcinoma in accordance with AJCC (7edt, 2010) classification. Pathologic specimen was reevaluated by an expert pathologist for the patient with progression and liver metastasis under adjuvant chemotherapy and concomitant radiotherapy. The new pathology was consistent with gastric carcinosarcoma, and 90% of the tumor was identified as osteosarcoma whereas 10% was identified as carcinoma. Cisplatin doxorubicine-based chemotherapy was given considering the fact that sarcomatous component was dominant.(1) The patient was given 3 courses of chemotherapy. However, as the patient showed progression under therapy, he died after 14months of the diagnosis. DISCUSSION Gastric carcinosarcoma is a very rare and clinically aggressive malignancy. Recurrence is likely to occur with a rate of more than 50% in patients who have undergone resection within the first year following surgery, and overall survival time is 10-15months. CONCLUSION In refractory gastric carcinoma cases with rapid progression, we suggest that gastric carcinosarcoma with biphasic component should be taken into consideration and the pathological evaluation should be performed by an expert pathologist.
Collapse
Affiliation(s)
- Fatih Selcukbiricik
- Istanbul University, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Medical Oncology, TR-34098 Istanbul, Turkey
| | | | | | | | | |
Collapse
|
30
|
Yamamoto D, Hamada Y, Tsubota Y, Kawakami K, Yamamoto C, Yamamoto M. Simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) in the stomach: case report. World J Surg Oncol 2012; 10:6. [PMID: 22230934 PMCID: PMC3271029 DOI: 10.1186/1477-7819-10-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/09/2012] [Indexed: 12/14/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) and adenocarcinoma are distinct neoplasms originating from different cell layers. Approximately 20% of patients with GIST develop other cancers. Case presentation We report a case of the coexistence of adenocarcinoma and gastrointestinal stromal tumor (GIST). Gastric endoscopy showed the ulcerated tumor with bleeding along the lesser curvature of the proximal stomach and a submucosal nodule that measured about 3 cm in diameter in the lower part of the stomach body. Their pathological examination showed gastric cancer (poorly differentiated diffuse adenocarcinoma) and GIST (low-risk category). Further, immunohistochemical staining for C-kit and CD34 was positive, while that for SMA and S-100 was negative. Conclusion Although it is not easy to speculate on the coexistence of adenocarcinoma and GIST, pre-and post-operative diagnoses may be essential, and such cancer development is not considered to be unusual.
Collapse
Affiliation(s)
- Daigo Yamamoto
- Department of Surgery, Kansai Medical University, Hirakata, Japan.
| | | | | | | | | | | |
Collapse
|
31
|
Kim TY, Chae HD. Composite neuroendocrine carcinoma with adenocarcinoma of the stomach misdiagnosed as a giant submucosal tumor. J Gastric Cancer 2011; 11:126-30. [PMID: 22076214 PMCID: PMC3204486 DOI: 10.5230/jgc.2011.11.2.126] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/17/2011] [Indexed: 12/21/2022] Open
Abstract
A composite glandular/exocrine-endocrine carcinoma of the gastrointestinal tract is characterized by the co-existence of two adjacent, but histologically-distinct tumors in an organ. Composite glandular/exocrine-endocrine carcinomas are a special type of tumor comprised of common adenocarcinomas and neuroendocrine components that account for at least one-third of the entire tumor area. Composite tumors have been reported in a range of organs, but are relatively rare in the stomach. We report a case of a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach (mixed exocrine-endocrine carcinoma), which was misdiagnosed as a giant submucosal tumor preoperatively based on esophagogastroduodenoscopy and a contrast-enhanced axial computed tomographic scan.
Collapse
Affiliation(s)
- Tae-Yoon Kim
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | | |
Collapse
|
32
|
Theodosopoulos T, Dellaportas D, Psychogiou V, Gennatas K, Kondi-Pafiti A, Gkiokas G, Papaconstantinou I, Polymeneas G. Synchronous gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) of the stomach: a case report. World J Surg Oncol 2011; 9:60. [PMID: 21615935 PMCID: PMC3115894 DOI: 10.1186/1477-7819-9-60] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 05/26/2011] [Indexed: 12/16/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract (1%), and stomach is the most common location involved. However, the co-existence of gastric adenocarcinoma and GIST is very rare. A case of an 80-year-old male with a simultaneous presentation of a gastric adenocarcinoma and GIST is presented. Various hypotheses have been proposed in order to explain this rare simultaneous development, but even though it's cause has not been proven yet.
Collapse
|
33
|
Won KY, Lee J, Kim YH, Kim YW. Collision Tumor Composed of a Granulocytic Sarcoma and an Adenocarcinoma of the Stomach - A Case Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.2.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyu Yeoun Won
- Department of Pathology, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yong Ho Kim
- Department of Surgery, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Youn Wha Kim
- Department of Pathology, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Mou YP, Xu XW, Xie K, Zhou W, Zhou YC, Chen K. Laparoscopic wedge resection of synchronous gastric intraepithelial neoplasia and stromal tumor: A case report. World J Gastroenterol 2010; 16:5005-8. [PMID: 20954290 PMCID: PMC2957612 DOI: 10.3748/wjg.v16.i39.5005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Synchronous occurrence of epithelial neoplasia and gastrointestinal stromal tumor (GIST) in the stomach is uncommon. Only rare cases have been reported in the literature. We present here a 60-year-old female case of synchronous occurrence of gastric high-level intraepithelial neoplasia and GIST with the features of 22 similar cases and detailed information reported in the English-language literature summarized. In the present patient, epithelial neoplasia and GIST were removed en bloc by laparoscopic wedge resection. To the best of our knowledge, this is the first reported case treated by laparoscopic wedge resection.
Collapse
|
35
|
Narasimhamurthy MS, Vallachira GP, Mahadev PS. Synchronous adenocarcinoma and gastrointestinal stromal tumor in the stomach. Saudi J Gastroenterol 2010; 16:218-20. [PMID: 20616420 PMCID: PMC3003220 DOI: 10.4103/1319-3767.65196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. In the stomach, adenocarcinoma has been described with coexisting primary rhabdomyosarcoma, carcinoid, and low-grade B-cell lymphoma of mucosa-associated lymphoid tissue. The simultaneous development of adenocarcinoma and gastric mesenchymal tumor has been documented rarely. We report one such case. A 65-year-old male was diagnosed with a proximal gastric adenocarcinoma and underwent subtotal gastrectomy. Subsequent histopathological examination revealed the presence of another tumor at the gastric antrum. This was a gastrointestinal stromal tumor of low risk category (GIST). The literature has only a few previous reports of this very rare association. It is not known whether this synchronicity is incidental or there is a causative factor inducing the development of tumors of different histotypes in the same organ. Pathologists, oncologists and surgeons should be aware of this interesting condition.
Collapse
Affiliation(s)
- Mohana S. Narasimhamurthy
- Department of Pathology, Sudharma Metropolis, Gastrosurgery, Palakkad District Hospital,Address for correspondence: Dr. Mohana S. N, Sudharma Metropolis, Thrissur-680 022, India. E-mail:
| | | | - Praveen S. Mahadev
- Department of Pathology, Sudharma Metropolis, Gastrosurgery, Palakkad District Hospital
| |
Collapse
|
36
|
Kleist B, Lasota J, Miettinen M. Gastrointestinal stromal tumor and gastric adenocarcinoma collision tumors. Hum Pathol 2010; 41:1034-9. [PMID: 20381123 DOI: 10.1016/j.humpath.2009.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/14/2009] [Accepted: 11/19/2009] [Indexed: 12/17/2022]
Abstract
Gastrointestinal stromal tumors sometimes occur together with gastric carcinoma, but true collision tumors featuring these 2 components are very rare. The authors describe here 2 collision tumors containing a gastrointestinal stromal tumor with intermingling elements of gastric adenocarcinoma. The gastrointestinal stromal tumors were 5.5 to 6 cm spindle cell tumors, and one patient had an additional prepyloric stromal tumor (2.5 cm). All gastrointestinal stromal tumors had low mitotic counts less than 5/50 high-power fields and were positive for KIT, DOG1, and CD34. Different KIT exon 11 mutations (single nucleotide substitution, complex insertion-duplication) in all tumors indicated that the 2 gastrointestinal stromal tumors in one patient were independent primary tumors. The adenocarcinoma components displayed gland-forming intestinal type to signet ring cell morphology with focally accompanying dysplastic epithelium, immunohistochemical positivity for CDX2, and varying keratin 7/20 expression. We hypothesize that development of gastric adenocarcinoma within a gastrointestinal stromal tumor may be based on displaced gastric epithelium in a long-standing stromal tumor with events of intermittent ulceration and epithelial regeneration.
Collapse
Affiliation(s)
- Britta Kleist
- Department of Pathology, Soerlandet sykehus HF, Serviceboks 416, N-4604 Kristiansand, Norway.
| | | | | |
Collapse
|
37
|
Joo YB, Choi SH, Kim SK, Shim B, Kim MS, Kim YJ. Synchronous development of KIT positive acute myeloid leukemia in a patient with gastrointestinal stromal tumor. THE KOREAN JOURNAL OF HEMATOLOGY 2010; 45:66-9. [PMID: 21120166 PMCID: PMC2983013 DOI: 10.5045/kjh.2010.45.1.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 01/11/2023]
Abstract
We report a case of synchronous occurrence of KIT-positive acute myeloid leukemia (AML) and gastrointestinal stromal tumor (GIST). A 63-year-old woman was hospitalized for dizziness, and abdominal computed tomography revealed an exophytic gastric mass and hepatic metastasis. The patient was diagnosed with GIST and was administered imatinib (400 mg/day) for the metastatic unresectable tumor. After 2 weeks of imatinib treatment, the patient developed pancytopenia, which persisted even after the drug was discontinued, thereby necessitating bone marrow biopsy. Biopsy examination indicated AML, and karyotyping revealed a complex karyotype. We did not observe point mutations at residues D816 and N822 of KIT. Therefore, the patient received standard induction chemotherapy, but on the 18th day after completion of chemotherapy, she died of septic shock and multi-organ failure. Since KIT plays an important role in both GIST and AML, we consider that both these malignancies may have been associated with each other.
Collapse
Affiliation(s)
- Young-Bin Joo
- Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | | | | | | | | | | |
Collapse
|
38
|
Bi R, Sheng W, Wang J. Collision tumor of the stomach: gastric adenocarcinoma intermixed with gastrointestinal stromal tumor. Pathol Int 2010; 59:880-3. [PMID: 20021614 DOI: 10.1111/j.1440-1827.2009.02460.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The synchronous occurrence of tumors of different histological types in the stomach is uncommon. This rare association is usually detected incidentally at gastroscopy, surgery or histopathology. It is still not known whether such association represents an incidental coexistence or indicates a similar pathogenesis in the simultaneous development of tumors of different histological types in the same organ. A 73-year-old woman complained of discomfort after eating a Chinese dumpling, and had tarry stools three times. Gastroscopy showed a tumor at the juncture of the gastric fundus and corpus. The tumor was composed of gastric adenocarcinoma and gastrointestinal stromal tumor, in which the two components were intermixed with each other. To the authors' knowledge there are few reports of this extremely rare collision tumor association.
Collapse
Affiliation(s)
- Rui Bi
- Department of Pathology, Institute of Cancer Research, Cancer Hospital, Fudan University, Department of Oncology, Shanghai Medical College, Shanghai, China.
| | | | | |
Collapse
|
39
|
Toyoda A, Komaba A, Yoshizumi H, Hanaoka R, Sakuma S, Ichinohe A, Kawana H, Harigaya K. Collision of advanced gastric adenocarcinoma and gastrointestinal stromal tumour: a case report. BMJ Case Rep 2009; 2009:bcr07.2009.2075. [PMID: 22110555 DOI: 10.1136/bcr.07.2009.2075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of an 83-year-old female patient with a collision tumour of an advanced Borrmann type 4 gastric cancer and a large gastric gastrointestinal stromal tumour (GIST). According to the deformity of the gastric wall caused by the GIST, type 4 cancer was difficult to identify by oesophagogastroduodenoscopy (OGD). The patient died of progressive gastric cancer related disease. While the mechanism of histogenesis of the simultaneous adenocarcinoma and GIST remains to be determined, the present case suggests that gastric adenocarcinoma has a more adverse effect on prognosis than does GIST. Additionally, this case suggests that thorough inspection of GIST patients is required at the OGD and at the pathology facility, in order to avoid overlooking the underlying cancer.
Collapse
Affiliation(s)
- Akihiro Toyoda
- Chiba University Graduate School of Medicine, Molecular and Tumor Pathology, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Tokunaga M, Ohyama S, Fujimoto Y, Hiki N, Fukunaga T, Yamamoto N, Yamaguchi T. Simultaneous adenocarcinoma and leiomyoma of the stomach presenting as a collision tumor. Clin J Gastroenterol 2009; 2:394-397. [PMID: 26192793 DOI: 10.1007/s12328-009-0109-5] [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: 01/03/2009] [Accepted: 09/07/2009] [Indexed: 12/16/2022]
Abstract
A 68-year old Japanese man was referred to the Cancer Institute Hospital for the treatment of a rectal cancer. Preoperative esophagogastroduodenoscopy revealed a submucosal tumor with ulcer formation near the esophagogastric junction of the stomach. The initial treatment strategy was to perform a proximal gastrectomy with limited lymph node dissection as well as a simultaneous anterior resection. However, histopathological examination of a biopsy specimen of the submucosal tumor revealed a moderately differentiated adenocarcinoma, and therefore a total gastrectomy with D2 lymph node dissection was performed. Histopathological examination of the resected specimen revealed both adenocarcinoma and leiomyoma presenting as a collision tumor. Preoperative accurate histopathological diagnosis of a gastric submucosal tumor is generally difficult. Consequently, surgical resection of large gastric submucosal tumors may be indicated in the absence of histopathological confirmation of the diagnosis. However, in this case preoperative histopathological diagnosis enabled surgeons to perform the appropriate surgery. We conclude that to determine the appropriate treatment strategy, preoperative histopathological examination of tumors should be performed even in a case of suspected submucosal tumor, particularly if mucosal ulceration is present.
Collapse
Affiliation(s)
- Masanori Tokunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shigekazu Ohyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yoshiya Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Noriko Yamamoto
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiharu Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| |
Collapse
|
41
|
Jang KY, Park HS, Chung MJ, Moon WS, Kang MJ, Lee DG, Kim YK, Kim CY. Synchronous occurrence of primary adenocarcinoma and schwannoma in the stomach: a case report. Pathology 2009; 41:286-9. [PMID: 19291543 DOI: 10.1080/00313020902756386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
42
|
Liu YJ, Yang Z, Hao LS, Xia L, Jia QB, Wu XT. Synchronous incidental gastrointestinal stromal and epithelial malignant tumors. World J Gastroenterol 2009; 15:2027-31. [PMID: 19399938 PMCID: PMC2675096 DOI: 10.3748/wjg.15.2027] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the incidence of incidental gastrointestinal stromal tumor (GIST) and its etiopathogenesis.
METHODS: From January 1, 2000 to December 31, 2007, 13 804 cases of gastrointestinal epithelial malignant tumor (EMT) and 521 cases of pancreatic adenocarcinoma (PAC) were successfully treated with surgery at the Department of General Surgery and the Department of Thoracic Surgery, West China Hospital, Sichuan University, China. The clinical and pathologic data of 311 cases of primary GIST, including 257 cases with clinical GIST and 54 cases of incidental GIST were analyzed.
RESULTS: Of the 311 patients, 54 had incidental GIST, accounting for 17.4%. Of these tumors, 27 were found in 1.13% patients with esophageal squamous cell carcinoma (ESCC), 22 in 0.53% patients with gastric adenocarcinoma (GAC), 2 in 0.38% patients with PAC, 2 in 0.03% patients with colorectal adenocarcinoma, and 1 in one patient with GAC accompanying ESCC, respectively. Patients with incidental GIST presented symptoms indistinguishable from those with EMT. All incidental GIST lesions were small in size, and the majority had a low mitotic activity while only 1.9% (5/257) of clinical GIST lesions had a high risk.
CONCLUSION: Incidental GIST may occur synchronously with other tumors and has a high prevalence in males. Surgery is its best treatment modality.
Collapse
|
43
|
[Gastrointerstinal stromal tumors of the stomach--case reports]. ACTA ACUST UNITED AC 2008; 61:409-13. [PMID: 19097381 DOI: 10.2298/mpns0808409r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors are the most common mesenchimal tumors of the gastrointestinal tract. Despite the enormous progress made in the field of diagnostics, most often diagnosis is made during the explorative laparotomy and postoperative immunohystochemical analysis of specimen. The surgical treatment is often indicated, although scarce preoperative diagnosis causes intraoperative dilemma concerning the level of radicality. MATERIAL AND METHODS In this paper we have analyzed two patients with gastric GIST. The first patient was 59 years old male, with preoperatively diagnosed colonic cancer. Intraoperatively besides the transverse colon cancer, we found intramural gastric tumor. This patient underwent subtotal gastrectomy and subtotal colectomy. The immunohystochemical analysis of gastric tumor proves benign GIST. The second patient was 50 year old male presented with repeated upper GI bleeding. The endoscopic ultrasound showed intramural tumor of the anterior gastric wall, with a visible blood vessel bleeding during endoscopy. After the resuscitation, we performed subtotal gastrectomy. The immunohystochemical analysis proved malignant GIST. DISCUSSION In the cases with inadequate preoperative diagnoses, the level of resection procedure is based on the size of tumor and the presence of necrosis and bleeding inside the tumor. Tumors larger than 5 cm in diameter with signs of necrosis and bleeding are parameters of malignant nature of GIST, therefore demanding a radical surgical treatment. CONCLUSION The surgical resection is a treatment of choice for gastrointestinal stromal tumors. It has been shown that adequate surgical resection correlates with high 5-years survival rates for patients with gastric GIST.
Collapse
|
44
|
Idema DLM, Daryanani D, Sterk LMT, Klaase JM. Collision tumor of the stomach: a case of an adenocarcinoma and a gastrointestinal stromal tumor. Case Rep Gastroenterol 2008; 2:456-60. [PMID: 21897799 PMCID: PMC3166811 DOI: 10.1159/000129707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A collision tumor of the stomach is a rare event. We report the case of a collision tumor of the stomach consisting of an adenocarcinoma and a gastrointestinal stromal tumor (GIST). This is, to our knowledge, the second report in the literature of such a case. A 71-year-old man with abdominal discomfort underwent an esophagogastroduodenoscopy which revealed a tumor of the oesophagogastric junction. A total gastrectomy was performed. Histologic examination showed a mixed tumor consisting of a primary adenocarcinoma and multiple nodules of GIST. The adenocarcinoma showed both diffuse and intestinal growth, angio-invasion and metastasis to lymph nodes. The GIST tumor cells were strongly immunoreactive to CD117 and CD34. Based on mitotic index, size and cytonuclear details, the biological behavior of this GIST tumor was supposed to be benign. This case reports the rare finding of a collision tumor consisting of an adenocarcinoma and a GIST with an unknown etiology.
Collapse
Affiliation(s)
- D L M Idema
- Department of Surgery, Medisch Spectrum Twente, The Netherlands
| | | | | | | |
Collapse
|
45
|
Camargo MA, Andreollo NA, Hatsumura TC, Lopes LR, Meirelles LR. Adenocarcinoma e tumor estromal (GIST) sincrônicos no estômago: uma rara ocorrência. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
46
|
Pamukçuoglu M, Budakoğlu B, Han O, Tad M, Oksüzoğlu B, Abali H, Zengin N. An extraordinary case in whom gastrointestinal stromal tumor and low-grade malignant lymphoma are seen together in the stomach. Med Oncol 2008; 24:351-3. [PMID: 17873313 DOI: 10.1007/s12032-007-0001-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 11/30/1999] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gastrointestinal system (GIS) is the most common site of involvement of all primary extranodal lymphomas. Gastric lymphoma constitutes 3-6% of all primary stomach malignancies. Stomach is also the commonest site of involvement of gastrointestinal stromal tumors (GIST). We would like to report these rare synchronous tumors in the same patient. CASE A 68-year-old male was admitted to the internal medicine clinics with the complaints of abdominal distension. Physical examination was normal. On abdominal computed tomography a 12 x 14 x 22 cm sized giant tumoral mass was detected in left hypochondrium. A total gastrectomy was performed. Two distinct neoplasms were detected; one of which was located in the posterior wall of the stomach with the size of 24 x 16 x 13 cm, and the other one was localized in the fundus of the stomach and its size was 6 x 5 x 2 cm. Pathological evaluation revealed the diagnosis of GIST at the posterior wall and low-grade malignant lymphoma from the mass localized in the fundus of the stomach. DISCUSSION Two primary tumors are not seen so often together in the stomach. Adenocarcinoma and associated tumors including gastric lymphoma (especially MALT lymphoma), carcinoid, leiomyosarcoma and rhabdomyosarcoma constitute most of the reported series. Rarely adenocarcinoma and associated GIST cases were reported. It is important to report concurrent gastric lymphoma and GIST case since it is extremely rare in the English literature.
Collapse
Affiliation(s)
- Merve Pamukçuoglu
- Uçüncü Dahiliye Kliniği, Ankara Numune Eğitim ve Araştirma Hastanesi, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
47
|
Synchronous adenocarcinoma and gastrointestinal stromal tumors of the stomach treated laparoscopically. Int J Clin Oncol 2007; 12:478-81. [PMID: 18071869 DOI: 10.1007/s10147-007-0684-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 04/15/2007] [Indexed: 12/17/2022]
Abstract
Gastric adenocarcinomas account for approximately 95% of primary gastric tumors, and gastrointestinal stromal tumor (GIST) is the most common gastrointestinal mesenchymal tumor, accounting for 1%-3% of primary gastric tumors. However, the synchronous occurrence of GIST and gastric epithelial tumor is rare. We herein report a case of synchronous occurrence of gastric adenocarcinoma and two GISTs of the stomach. All lesions were resected laparoscopically. We discuss this case and review the literature.
Collapse
|
48
|
Uchiyama S, Nagano M, Takahashi N, Hidaka H, Matsuda H, Nagaike K, Maehara N, Hotokezaka M, Chijiiwa K. Synchronous adenocarcinoma and gastrointestinal stromal tumors of the stomach treated laparoscopically. Int J Clin Oncol 2007. [PMID: 18071869 DOI: 10.11007/s10147-007-068408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gastric adenocarcinomas account for approximately 95% of primary gastric tumors, and gastrointestinal stromal tumor (GIST) is the most common gastrointestinal mesenchymal tumor, accounting for 1%-3% of primary gastric tumors. However, the synchronous occurrence of GIST and gastric epithelial tumor is rare. We herein report a case of synchronous occurrence of gastric adenocarcinoma and two GISTs of the stomach. All lesions were resected laparoscopically. We discuss this case and review the literature.
Collapse
Affiliation(s)
- Shuichiro Uchiyama
- Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Kiyotake, Miyazaki, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lee FY, Jan YJ, Wang J, Yu CC, Wu CC. Synchronous gastric gastrointestinal stromal tumor and signet-ring cell adenocarcinoma: a case report. Int J Surg Pathol 2007; 15:397-400. [PMID: 17913950 DOI: 10.1177/1066896907302369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Synchronous tumors of the stomach are uncommon. We present a unique case of gastric synchronous tumors composed of signet-ring cell adenocarcinoma and gastrointestinal stromal tumor (GIST). The two tumors arose at the same site and were sharply juxtaposed without intermingling of morphologically distinct elements. Coincidence probably accounts for this occurrence, even if a common carcinogenic agent had been hypothesized. Preoperative imaging and endoscopic biopsy could lead to the suspicion of synchronous tumors, and an accurate histological identification of both tumors could be achieved by multiple deep endoscopic biopsies. The presence in our case of diffuse carcinomatosis indicates that the signet-ring cell adenocarcinoma had a greater adverse effect on the prognosis than the GIST.
Collapse
MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Biopsy
- Carcinoma, Signet Ring Cell/diagnosis
- Carcinoma, Signet Ring Cell/metabolism
- Carcinoma, Signet Ring Cell/surgery
- Endoscopy, Gastrointestinal
- Gastrointestinal Stromal Tumors/diagnosis
- Gastrointestinal Stromal Tumors/metabolism
- Gastrointestinal Stromal Tumors/surgery
- Humans
- Keratins/metabolism
- Male
- Mucins/metabolism
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/metabolism
- Neoplasms, Multiple Primary/surgery
- Periodic Acid-Schiff Reaction
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/surgery
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Fang-Yi Lee
- Department of Pathology, Taichung Veterans Genral Hospital, College of Medicine, Chung Shan Medical University, No. 160 Section 3 Chung-Kang Road, Taichung, Taiwan 00407, ROC.
| | | | | | | | | |
Collapse
|
50
|
Randjelovic T, Filipovic B, Babic D, Cemerikic V, Filipovic B. Carcinosarcoma of the stomach: A case report and review of the literature. World J Gastroenterol 2007; 13:5533-6. [PMID: 17907304 PMCID: PMC4171295 DOI: 10.3748/wjg.v13.i41.5533] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Carcinosarcomas are rare, malignant, biphasic tumors. We report the case of a 62-year-old man with gastric carcinosarcoma, along with its clinical, macroscopic and histopathological features. Macroscopically, a specimen of deformed stomach was obtained that measured 200 mm × 150 mm × 100 mm. A 150 mm × 100 mm × 50 mm exophytic tumoral mass (Borrmann typeI) was found, which involved the posterior wall from the cardia to the antrum. Histopathologically, a mixed type of malignancy was revealed: an adenocarcinoma with intestinal metaplasia, with interposed fascicles of fusiform atypical cells and numerous large, rounded and oval cells. The tumor showed positive histochemistry for cytokeratin 18, epithelial membrane antigen, carcinoembryonic antigen, chromogranin A and vimentin. Liver metastases were diagnosed 8 mo postoperatively, and the patient died 4 mo later. A review of the available literature is also presented.
Collapse
Affiliation(s)
- Tomislav Randjelovic
- Department of Gastroenterohepatology, Clinical and Hospital Center Bezanijska Kosa, Belgrade 11080, Serbia
| | | | | | | | | |
Collapse
|