Clin Endosc.  2019 Jan;52(1):76-79. 10.5946/ce.2018.062.

Primary Gastric Small Cell Carcinoma: A Case Identified as a Large Subepithelial Tumor from Invisible State in 6 Months

Affiliations
  • 1Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. benjamin@uuh.ulsan.kr
  • 2Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Abstract

Primary gastric small cell carcinoma (GSCC) is one of the gastroenteropancreatic neuroendocrine tumors. It is a rare cancer with a very aggressive behavior and a poor prognosis because of the high rate of metastases. It is usually found in far advanced stage. We experienced a case of GSCC which had developed into a large subepithelial tumor (SET) from invisible state in a short period. A 65-year-old man consulted our hospital because of early gastric cancer. He underwent endoscopic submucosal dissection for the early gastric cancer at high body posterior wall. After 6 months, the follow-up endoscopy showed a large newly developed SET-like lesion with central ulceration at the gastric cardia. Endoscopic biopsy revealed GSCC. Total gastrectomy was performed. One out of the 26 perigastric lymph nodes had a metastasis. He received 6 cycles of adjuvant chemotherapy with etoposide and cisplatin. He is still in good health 12 months after operation.

Keyword

Carcinoma, small cell; Neuroendocrine tumors; Stomach; Subepithelial tumor

MeSH Terms

Aged
Biopsy
Carcinoma, Small Cell*
Cardia
Chemotherapy, Adjuvant
Cisplatin
Endoscopy
Etoposide
Follow-Up Studies
Gastrectomy
Humans
Lymph Nodes
Neoplasm Metastasis
Neuroendocrine Tumors
Prognosis
Stomach
Stomach Neoplasms
Ulcer
Cisplatin
Etoposide

Figure

  • Fig. 1. Endoscopic images. (A) Early gastric cancer lesion (arrow). (B) Ulcer after endoscopic submucosal dissection (ESD). (C, D) Follow-up endoscopy after 6 months. The image presents the post-ESD scar at the high body posterior wall side of the stomach (arrow) and the mass at the gastric cardia (C). (D) A closer image of the mass.

  • Fig. 2. Specimen obtained from endoscopic biopsy. (A) Histopathological evaluation reveals small cells with scant cytoplasm, ill-defined cell borders, finely granular nuclear chromatin, and absent nucleoli (Hematoxylin and eosin stainining, ×400). (B) Positive staining for CD56, ×40. (C) Positive staining for pancytokeratin, ×40. (D) Positive staining for thyroid transcription factor-1, ×40.

  • Fig. 3. (A) Abdomino-pelvic computed tomography (CT) showing no abnormalities. (B) Positron emission tomography-CT showing a hypermetabolic lesion (SUV max: 3.8) in the stomach (arrow).

  • Fig. 4. Specimen obtained after surgery. Gross picture of the surgical specimen showing the mass (arrow).

  • Fig. 5. Histopathological evaluation and immunohistochemistry. (A) Microscopic finding showing mitosis of the tumor (Hematoxylin and eosin staining, ×400). (B) Ki-67: 90%, ×40. (C) Positive staining for CD56, ×40. (D) Positive staining for synaptophysin, ×40.


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