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Case of a tumor comprising gastric cancer and duodenal neuroendocrine tumor

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ABSTRACT

The present report describes a rare case of a tumor composed of early gastric cancer and a duodenal neuroendocrine tumor (NET). A 78-year-old woman underwent esophagogastroduodenoscopy at a local institution for screening of the upper gastrointestinal tract which revealed a protruded tumor through the pyloric ring from the pyloric antrum. The tumor was too large to treat at the facility; consequently, she was referred to our hospital for further management. Esophagogastroduodenoscopy with tumor biopsy of the lesion revealed the diagnosis of early gastric cancer. Endoscopic submucosal dissection was performed with sufficient free margins in both vertical and horizontal directions. Histopathological findings showed NET confined to the submucosal layer and covered by well-differentiated adenocarcinoma. Immunohistochemical stainings showed that the two lesions existed continuously. While the possibility of a collision cancer was considered, it was suggested that the two lesions existed continuously. Finally, the tumor was diagnosed as gastric cancer composed of duodenal NET G1, with a lymphatic invasion of NET component.

No MeSH data available.


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Esophagogastroduodenoscopic views of the tumor in the stomach. A: The protruded tumor occupied and existed beyond the pyloric ring, the whole tumor could not fit in one field of view; B: Image observed by inverting the endoscope in the duodenal bulb; C: Magnifying endoscopy with narrow-band imaging showed sturucture irregularities compared with the normal surrounding mucosa.
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Figure 1: Esophagogastroduodenoscopic views of the tumor in the stomach. A: The protruded tumor occupied and existed beyond the pyloric ring, the whole tumor could not fit in one field of view; B: Image observed by inverting the endoscope in the duodenal bulb; C: Magnifying endoscopy with narrow-band imaging showed sturucture irregularities compared with the normal surrounding mucosa.

Mentions: No abnormalities were found on physical examination, including vital signs, and routine laboratory analyses. Serum levels of tumor markers such as carcinoembryonic antigen and carbohydrate antigen 19-9 were 2.9 ng/mL and 9 U/mL, respectively. Computed tomography of the abdomen revealed no mass in the gastrointestinal tract and no lymph node swelling or metastasis. EGD revealed a protruded tumor with a diameter of approximately 20 mm over the bulb from the pylorus antrum (Figure 1A and B). Magnifying endoscopy with narrow-band imaging showed irregularities in the structures and vessels of the tumor, which led to the suspicion of early gastric cancer (Figure 1C). Biopsy from the gastric portion of the tumor revealed well-differentiated adenocarcinoma. We were unable to investigate the whole tumor because it occupied and existed beyond the pyloric ring; however, there were no obvious signs suggesting submucosal tumor invasion. Although the tumor extended to the duodenum, the major part of the tumor was from the stomach. Finally, the diagnosis was early gastric cancer, and ESD was recommended.


Case of a tumor comprising gastric cancer and duodenal neuroendocrine tumor
Esophagogastroduodenoscopic views of the tumor in the stomach. A: The protruded tumor occupied and existed beyond the pyloric ring, the whole tumor could not fit in one field of view; B: Image observed by inverting the endoscope in the duodenal bulb; C: Magnifying endoscopy with narrow-band imaging showed sturucture irregularities compared with the normal surrounding mucosa.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037094&req=5

Figure 1: Esophagogastroduodenoscopic views of the tumor in the stomach. A: The protruded tumor occupied and existed beyond the pyloric ring, the whole tumor could not fit in one field of view; B: Image observed by inverting the endoscope in the duodenal bulb; C: Magnifying endoscopy with narrow-band imaging showed sturucture irregularities compared with the normal surrounding mucosa.
Mentions: No abnormalities were found on physical examination, including vital signs, and routine laboratory analyses. Serum levels of tumor markers such as carcinoembryonic antigen and carbohydrate antigen 19-9 were 2.9 ng/mL and 9 U/mL, respectively. Computed tomography of the abdomen revealed no mass in the gastrointestinal tract and no lymph node swelling or metastasis. EGD revealed a protruded tumor with a diameter of approximately 20 mm over the bulb from the pylorus antrum (Figure 1A and B). Magnifying endoscopy with narrow-band imaging showed irregularities in the structures and vessels of the tumor, which led to the suspicion of early gastric cancer (Figure 1C). Biopsy from the gastric portion of the tumor revealed well-differentiated adenocarcinoma. We were unable to investigate the whole tumor because it occupied and existed beyond the pyloric ring; however, there were no obvious signs suggesting submucosal tumor invasion. Although the tumor extended to the duodenum, the major part of the tumor was from the stomach. Finally, the diagnosis was early gastric cancer, and ESD was recommended.

View Article: PubMed Central - PubMed

ABSTRACT

The present report describes a rare case of a tumor composed of early gastric cancer and a duodenal neuroendocrine tumor (NET). A 78-year-old woman underwent esophagogastroduodenoscopy at a local institution for screening of the upper gastrointestinal tract which revealed a protruded tumor through the pyloric ring from the pyloric antrum. The tumor was too large to treat at the facility; consequently, she was referred to our hospital for further management. Esophagogastroduodenoscopy with tumor biopsy of the lesion revealed the diagnosis of early gastric cancer. Endoscopic submucosal dissection was performed with sufficient free margins in both vertical and horizontal directions. Histopathological findings showed NET confined to the submucosal layer and covered by well-differentiated adenocarcinoma. Immunohistochemical stainings showed that the two lesions existed continuously. While the possibility of a collision cancer was considered, it was suggested that the two lesions existed continuously. Finally, the tumor was diagnosed as gastric cancer composed of duodenal NET G1, with a lymphatic invasion of NET component.

No MeSH data available.


Related in: MedlinePlus