Neuroendocrine carcinoma of the gastric stump: A case report and literature review

Abstract

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-year-old man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin (EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computed tomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first- and second-line settings. The patient died of disease progression 31 months after surgery.

Mixed neuroendocrine carcinoma of the gastric stump: A case report

“…The carcinogenesis of GRC is closely related to chronic duodenogastric reflux of bile or pancreatic juice, sometimes it also related to hypochlorhydria second to denervation after vagotomy[ 9 - 11 ]. In the present case, the Braun anastomosis site was only approximately 5 centimeters away from the gastrojejunostomy site, which explains why a large amount of bile and pancreatic juice refluxed.…”

“…After surgery, adjuvant chemotherapy should also be provided[ 11 , 16 , 17 ]. However, there is no standardized chemotherapy for GMNECs because of the rarity of these tumors.…”

Pathologic Complete Response After Neoadjuvant Chemoradiation in a Patient with Gastric Neuroendocrine Cancer

“…Neuroendocrine tumors of the stomach can be divided into three distinct types based on the World Health Organization’s (WHO's) classification system. These types include well-differentiated carcinoid, well-differentiated neuroendocrine carcinoma, and poorly differentiated neuroendocrine carcinoma [6,8,12]. Neuroendocrine tumors can be divided into grades 1, 2, and 3 based on their Ki-67 index indicating mitotic activity [8].…”

“…These types include well-differentiated carcinoid, well-differentiated neuroendocrine carcinoma, and poorly differentiated neuroendocrine carcinoma [6,8,12]. Neuroendocrine tumors can be divided into grades 1, 2, and 3 based on their Ki-67 index indicating mitotic activity [8]. Rindi et al proposed a system of gastric neuroendocrine tumors, which are classified according to presentation, etiology, and pathophysiology [13].…”

“…Under this classification: type 1 is characterized by chronic atrophic gastritis and hypergastrinemia; type 2 is associated with multiple endocrine neoplasia type 1 Zollinger-Ellison syndrome and hypergastrinemia [5]; type 3 is marked by a gastrin-independent tumor process, which is typically the most aggressive neuroendocrine tumor [5]. In the Japanese classification system, neuroendocrine carcinomas of gastric origin can be classified as either small cell or large cell [8].…”