Chonnam Med J.  2008 Dec;44(3):188-193. 10.4068/cmj.2008.44.3.188.

A Case of Gastric Adenocarcinoma Developed in Neuroendocrine Carcinoma after Chemotherapy

• Lim SU
• Seo SR
• Yoon JY
• Cho DH
• Bae SY
• Bae WK
• Shim HJ
• Cho SH
• Chung IJ

• KMID: 2172301
• DOI: http://doi.org/10.4068/cmj.2008.44.3.188

Abstract

A 69-year-old male visited our medical center with hematemesis. Gastrofibroscopy revealed a 4.5 cm sized fungating mass on anterior wall of gastric lower body. Biopsy specimens showed a carcinoma of neuroendocrine components with strong positive for synaptophysin stain. Because he had a metastatic neuroendocrine carcinoma with multiple metastasis of liver, we treated him with chemotherapy of etoposide and cisplatin. The primary lesion showed nearly complete response after 6th cycles of chemotherapy, however it was regrowed with chemoresistance and mutifocal lesion in stomach and liver. Endoscopic biopsy on same previous lesion revealed a poorly differentiated tubular adenocarcinoma with negative for synaptophysin. After conversion to another tumor type, the treatment outcome was progressed in spite of salvage chemotherapy for gastric adenocarcinoma. He died 17 months after diagnosis. The immunohistological change of same mass after chemotherapy suggests a possibility of other course of differentiation from common pleuripotent cells of adenocarcinoma and neuroendocrine carcinoma after chemotherapy.

Keyword

Stomach; Carcinoma, Neuroendocrine; Adenocarcinoma

MeSH Terms

Adenocarcinoma
Aged
Biopsy
Carcinoma, Neuroendocrine
Cisplatin
Etoposide
Hematemesis
Humans
Liver
Male
Neoplasm Metastasis
Stomach
Synaptophysin
Treatment Outcome
Cisplatin
Etoposide
Synaptophysin

Figure

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  Fig. 1 Endoscopic finding. (A) Anterior wall side of gastric lower body shows a 4-5 cm sized large protruding submucosal mass-like lesion with exudates and exposed vessels at diagnosis. (B) The mass of same lesion shows dramatic regression after 3rd EP chemotherapy. (C) Anterior wall side of gastric upper body shows a new ulcerative lesion after 9th EP chemotherapy. (D) The same lesion shows a 7 cm sized aggressive mass with multiple ulceration and exudate at 15 momths from diagnosis.

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  Fig. 2 The histology at diagnosis revealed relatively smaller tumor cells with granular cytoplasm, centrally located round nuclei (A, hematoxylin&eosin staining, ×100) and strong positive for synaptophysin (B, ×400). After 9th EP chemotherapy, it showed a neoplasm with a poorly differentiated conventional glandular carcinoma (C, hematoxylin&eosin staining, ×100) and negative for synaptophysin (D, ×400).

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  Fig. 3 (A) CT finding shows a 3.4 cm sized biggest metastatic lesion (arrow) located in Rt. lobe of liver at diagnosis. (B) PET finding shows four metastatic lesions of liver in both lobe of liver at diagnosis. (C) It shows almost regression of the same biggest lesion (arrow) in liver during 1st line EP regimen. (D) It shows a progressed lesion with another feature in same location of previously shown mass (arrow) at 15 months from diagnosis.

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