Ann Surg Treat Res.  2018 May;94(5):270-273. 10.4174/astr.2018.94.5.270.

Mixed adenoneuroendocrine carcinoma in the stomach: a case report with a literature review

• Kim KH
• Lee HJ
• Lee SH
• Hwang SH

• KMID: 2410271
• DOI: http://doi.org/10.4174/astr.2018.94.5.270

Abstract

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare disease that was first defined in the 2010 World Health Organization classification of endocrine tumors. We present the case of a 65-year-old man with an ulcerative depressed lesion measuring 3 cm in diameter and found in the lower gastric body. It was diagnosed as a MANEC, and we performed subtotal gastrectomy with D2 lymph node dissection. The patient is still alive, and no recurrence was observed at a 12-month follow-up. Most MANECs tend to have a poor prognosis. Curative resection, including an adequate lymph node dissection, should be considered, and intense follow-up is needed.

Keyword

Adenoneuroendocrine; Stomach; Stomach neoplasms

MeSH Terms

Aged
Classification
Follow-Up Studies
Gastrectomy
Humans
Lymph Node Excision
Prognosis
Rare Diseases
Recurrence
Stomach Neoplasms
Stomach*
Ulcer
World Health Organization

Figure

• 

  Fig. 1 Gross specimen opened at greater curvature. It shows a well-defined ovoid submucosal mass (mass 1) with mucosal ulceration, measuring 2.5 cm × 1.7 cm in size lower body of anterior wall. And it shows a well-defined multinodular submucosal mass (mass 2) at lesser curvature of lower body, measuring 4.7 cm × 2.8 cm in size. The masses 1 and 2 show yellow white homogenous cut surface without necrosis. The mass 2 is involving mucosa and extend to subserosa, grossly.

• 

  Fig. 2 (A) Mass 1 is composed of adenocarcinoma and grade 2 neuroendocrine tumor (H&E, ×40) Adenocarcinoma component (arrowed), Neuroendocrine tumor component (encircled). (B) An enlarged view of adenocarcinoma component (30%) with tubular, moderately differentiated (H&E, ×100). (C) An enlarged view of neuroendocrine tumor component (70%) with grade 2 neuroendocrine neoplasm by World Health Organization 2010 (H&E, ×200). (D) Mitosis is present: 2/10 HPFs (H&E, ×400).

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  Fig. 3 Immunohistochemistry of neuroendocrine component. (A) Synaptophysin (×40), (B) CD56 (×40), (C) chromogranin (×100), (D) Ki67. Neuroendocrine component is positive for synaptophysin, CD56, focal positive chromogranin, Ki67 proliferation index is 4.5%, otherwise adenocarcinoma component is negative for immunoreactivity (×400).

Reference

1. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. 4th ed. Lyon: International Agency for Research on Cancer;2010. p. 417.

2. Kim JJ, Kim JY, Hur H, Cho YK, Han SU. Clinicopathologic significance of gastric adenocarcinoma with neuroendocrine features. J Gastric Cancer. 2011; 11:195–199.

3. 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; 46:280–283.

4. Fukuba N, Yuki T, Ishihara S, Sonoyama H, Tada Y, Kusunoki R, et al. Gastric mixed adenoneuroendocrine carcinoma with a good prognosis. Intern Med. 2014; 53:2585–2588.

5. Sugishita K, Tanno M, Kijima M, Kamoshita H, Mitamura T, Hayakawa K. Malignant hypercalcemia due to gastric endocrine cell carcinoma. Intern Med. 1995; 34:104–107.

6. Volante M, Righi L, Berruti A, Rindi G, Papotti M. The pathological diagnosis of neuroendocrine tumors: common questions and tentative answers. Virchows Arch. 2011; 458:393–402.

7. Hervieu V, Scoazec JY. Mixed endocrine tumors. Ann Pathol. 2005; 25:511–528.

8. Levi Sandri GB, Carboni F, Valle M, Visca P, Garofalo A. Mixed adenoneuroendocrine gastric carcinoma: a case report and review of the literature. J Gastric Cancer. 2014; 14:63–66.

9. Gurzu S, Kadar Z, Bara T, Bara T Jr, Tamasi A, Azamfirei L, et al. Mixed adenoneuroendocrine carcinoma of gastrointestinal tract: report of two cases. World J Gastroenterol. 2015; 21:1329–1333.

10. Kwok CM. Mixed Adenoneuroendocrine Carcinoma of the Stomach. Case Rep Gastroenterol. 2015; 9:241–245.