Gastric Synchronous Stromal Tumor and Adenocarcinoma: A Fortuitous Association?

Abstract

The association of an adenocarcinoma with a stromal tumor in the stomach is rarely observed. We report the observation of a patient operated for a synchronous tumor associating subcardial adenocarcinoma with a stromal tumor of the gastric body. It is a 74 year-old patient, diabetic, who was admitted, in December 2016, for epigastralgia associated with vomiting evolving for 2 months. Physical examination was strictly normal. An oesogastroduodenal fibroscopy was performed showing a subcardial ulcerative budding formation with a 3 cm diameter and the presence, in the gastric body, of a second sub mucosal nodular formation with a 4 cm diameter. The anatomopathological examination of the biopsies concluded to an infiltrating and slightly differentiated adenocarcinoma at the subcardial level associated with chronic HP+ gastritis without signs of malignancy. The computed tomography, performed as part of the extension study, revealed a macro-lobulated tissue mass, posterior, pre-pyloric, with submucosal development, prolapsed in the peritoneum whose enhancement characteristics evoke a stromal tumor but also an irregular gastric cardio-tuberosal thickening predominant on the small gastric curvature and associated with necrotic pre-gastric centimetric satellite ganglia. The patient had a total gastrectomy with lymph node dissection type D1, 5 and oesojejunal anastomosis on a Y-shaped loop. The anatomo-pathological examination of the surgical specimen concluded to a slightly differentiated adenocarcinoma of the cardia classified as pT3N2 associated with a stromal tumor of the gastric body Synchronous development of gastric adenocarcinoma and GIST is rare. During this association, the stromal tumor is often characterized by low risk of recidivism.