Extrapulmonary Small Cell Carcinoma of the Stomach: A Lethal Entity

Small cell carcinoma of the stomach: A report of two cases and a review of the literature

Primary small cell gastric carcinomas (SCGC) are rare tumors with an aggressive nature, characterized by early, widespread metastases and poor overall prognosis. SCGC shares similar clinicopathological and molecular characteristics with small cell lung carcinoma and is usually treated in a similar manner. Here, two cases of SCGC in young Caucasian male patients are presented. One patient had metastatic and the other locoregional disease. Multimodal treatment was applied in each case; the resulting survival time was 20.2 months in the patient with initially locoregional disease whereas the remains alive and disease-free 20 months after initial diagnosis. A review of the literature is also presented.

Gastric small-cell carcinoma found on esophagogastroduodenoscopy: a case report and literature review

Introduction. Characterized as an undifferentiated, neuroendocrine tumor arising from totipotent stem cells, small-cell carcinoma (SCC) most commonly arises from the lung. Extrapulmonary small-cell carcinomas (ESCC) are rare and account for only four percent of SCC. Gastric ESCC, more commonly seen in Japanese male patients in their seventh decade of life, accounts for approximately 0.1 percent of ESCC. Case Presentation. A 75-year-old Hispanic male presented with a several week history of worsening epigastric pain with nausea and vomiting. Computer tomography (CT) of the abdomen and pelvis showed a large heterogeneous mass involving the posterior gastric wall with diffuse extension into the gastric cardia. Esophagogastroduodenoscopy (EGD) revealed a large fungating mass in the lesser curvature of the stomach. Biopsy of the mass revealed small-cell carcinoma of the stomach. The patient was diagnosed with extensive/stage 4 disease and started on chemoradiation. Discussion. Our case, of a very rare condition highlights, the importance of recognizing atypical pathologic diagnoses. More research will need to be conducted with GSCC patients in order to better characterize disease pathogenesis, genetic mutations, and optimal disease management. The hope is to identify biomarkers that will identify patients earlier in their disease course when cure is possible.

Primary small cell carcinoma of the stomach: a case report with an immunohistochemical and molecular genetic analysis

Small cell carcinoma (SCC) of the stomach is extremely rare; about 110 cases have been reported in the world literature. Immunohistochemical studies of various antigens and genetic studies of KIT and platelet-derived growth factor-α (PDGFRA) have not been performed in gastric SCC. An 84-year-old man consulted our hospital because of epigastralgia and weakness. Blood test showed anemia and increased CA19-9 (233 U/ml). Endoscopic examination revealed a large Borrmann type III tumor measuring 6x8 cm in the stomach. Biopsies from the tumor revealed typical small cell carcinoma with very scant cytoplasm, hyperchromatic nuclei, absent nucleoli, molded nuclei, and increased nucleo-cytoplasmic ratio. Immunohistochemically, the tumor cells were positive for pancytokeratin (PCK) WSS, PCK MNF-116, PCK AE1/3, PCK CAM5.2, cytokeratin (CK) 34BE12, CK 5/6, CK7, CK8, CK18, vimentin, EMA, KIT (CD117), CD56, synaptophysin, chromogranin, NSE, CA19-9, CEA, p53 protein, and Ki67 antigen (Ki-67 labeling = 60%). The tumor cells were negative for CK14, CK19, CK20, PDGFRA, CD45, CD45RO, CD3, CD20, CD30, and CD79a. A retrospective genetic analysis using PCR-direct sequencing method in paraffin sections identified no mutations of KIT (exons 9, 11, 13 and 17) and PDGFRA (exons 12 and 18) genes. Various imaging modalities including CT and MRI showed multiple small metastases in the liver, bilateral lungs, and perigastric lymph nodes. The patient was thus inoperative. The patient is now treated by cisplatin-based chemotherapy four months after the first manifestation.