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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.


Related in: MedlinePlus

A macroscopic view of the specimen resected by endoscopic submucosal dissection. A: Macroscopic appearance of the specimen soaked for almost 24 h in formalin after endoscopic submucosal dissection. The red dotted line indicates where there was a pyloric ring; B: Cut out of the resected specimen. The solid red line indicates adenocarcinoma; green line indicates neuroendocrine tumor; red dotted line indicates the location of the pylorus.
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Figure 2: A macroscopic view of the specimen resected by endoscopic submucosal dissection. A: Macroscopic appearance of the specimen soaked for almost 24 h in formalin after endoscopic submucosal dissection. The red dotted line indicates where there was a pyloric ring; B: Cut out of the resected specimen. The solid red line indicates adenocarcinoma; green line indicates neuroendocrine tumor; red dotted line indicates the location of the pylorus.

Mentions: Figure 2 shows a macroscopic view of the resected specimen. The resected mucosa and the tumor measured 54 mm × 40 mm and 38 mm × 32 mm, respectively. The histopathology results showed the resected specimen had sufficient free margins in both vertical and horizontal directions, but the tumor consisted of two components: The first part with irregular atypical epithelium, which formed a tubular and papillary structure confined to the mucosal layer, was a well differentiated adenocarcinoma, and the second part was located near the edge of duodenum side of the specimen and showed a mass composed of nests of small uniform tumor cells, which is typical of NET (Figure 3A-C). These cells were positive for CD56 (Figure 3D), synaptophysin (Figure 3E), and chromogranin A (Figure 3F), and the Ki-67 labeling index was less than 1%. According to the WHO 2010 classification, obvious nuclear fission images were not admitted and finally the NET was diagnosed as G1[3]. The NET cells were detected from the mucosal layer over the submucosa, but no infiltration of the muscle layer was recognized.


Case of a tumor comprising gastric cancer and duodenal neuroendocrine tumor
A macroscopic view of the specimen resected by endoscopic submucosal dissection. A: Macroscopic appearance of the specimen soaked for almost 24 h in formalin after endoscopic submucosal dissection. The red dotted line indicates where there was a pyloric ring; B: Cut out of the resected specimen. The solid red line indicates adenocarcinoma; green line indicates neuroendocrine tumor; red dotted line indicates the location of the pylorus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A macroscopic view of the specimen resected by endoscopic submucosal dissection. A: Macroscopic appearance of the specimen soaked for almost 24 h in formalin after endoscopic submucosal dissection. The red dotted line indicates where there was a pyloric ring; B: Cut out of the resected specimen. The solid red line indicates adenocarcinoma; green line indicates neuroendocrine tumor; red dotted line indicates the location of the pylorus.
Mentions: Figure 2 shows a macroscopic view of the resected specimen. The resected mucosa and the tumor measured 54 mm × 40 mm and 38 mm × 32 mm, respectively. The histopathology results showed the resected specimen had sufficient free margins in both vertical and horizontal directions, but the tumor consisted of two components: The first part with irregular atypical epithelium, which formed a tubular and papillary structure confined to the mucosal layer, was a well differentiated adenocarcinoma, and the second part was located near the edge of duodenum side of the specimen and showed a mass composed of nests of small uniform tumor cells, which is typical of NET (Figure 3A-C). These cells were positive for CD56 (Figure 3D), synaptophysin (Figure 3E), and chromogranin A (Figure 3F), and the Ki-67 labeling index was less than 1%. According to the WHO 2010 classification, obvious nuclear fission images were not admitted and finally the NET was diagnosed as G1[3]. The NET cells were detected from the mucosal layer over the submucosa, but no infiltration of the muscle layer was recognized.

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