Primary small cell carcinoma of the stomach

Abstract

We report on an 80-year-old man with primary gastric small cell carcinoma (SmCC). He was admitted to hospital with hematemesis. An upper gastrointestinal examination revealed an irregularly ulcerated tumor, 60 mm in diameter, on the lesser curvature of the stomach body extending to the cardia. An endoscopic biopsy revealed a solid proliferation of intermediate-sized tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for neuron-specific enolase and chromogranin A, but negative for carcinoembryonic antigen. No tumor was detected on examination of the chest. Therefore, primary gastric SmCC was diagnosed preoperatively. To date, only 38 cases of primary gastric SmCC, including our case, have been reported. By using endoscopic biopsy, approximately two-thirds of cases have been diagnosed incorrectly. In the reported cases of gastric SmCC, the endoscopic findings frequently indicated a submucosal tumor. Gastric SmCC is clinically aggressive and has an extremely poor prognosis, even when discovered at an early stage. Most patients with gastric SmCC die within 1 year of diagnosis. Although a standard treatment for gastric SmCC has not been established, intensive chemotherapy should be considered to promote long-term survival. We believe that careful examination, including immunohistochemical investigation, is necessary for determining the therapeutic strategy whenever gastric SmCC is suspected during endoscopy.

Poorly Differentiated Carcinomas of the Foregut (Gastric, Duodenal and Pancreatic)

“…PDECs of the stomach account for approximately 6% of gastric endocrine tumors[ 4]. Males are more frequently affected than females (M:F ratio 3:1) and the mean age at diagnosis is 64 years[ 3, 5]. Most patients have regional or distant metastases at presentation and lack hormone overproduction syndrome.…”

A successful treatment for metastatic liver tumors from endocrine carcinoma of the stomach

“…A combination of CDDP and VP16, which is a standard regimen for extensive SCLCs (10), demonstrates a high response against gastric ECs. In contrast to SCLCs, ECs of the stomach are often accompanied by a non-small cell component, such as an adenocarcinoma or a squamous cell carcinoma (4,5,11). Therefore, careful attention should be paid to the choice of anti-cancer agents for composite-type gastric ECs, as chemosensitivities vary for each carcinoma cell type.…”

“…ECs of the stomach account for only 0.1 to 0.9% of all gastric carcinomas (2,3), and reveal prominently aggressive behavior, which differ from conventional gastric carcinomas (1,4). In general, EC patients have very poor prognoses in spite of surgical resections and subsequent chemotherapies, and die within a year of diagnosis (1,4,5). However, with the occurrence of new anti-cancer agents and improvements in interventional treatments (6), the number of long-term survivors with gastric ECs has increased.…”

Application of Immunohistochemistry in Gastrointestinal and Liver Neoplasms: New Markers and Evolving Practice

“…On the other hand, primary high-grade neuroendocrine carcinomas of the GI tract are relatively rare. 84 When such a tumor is encountered, it is important to exclude the possibility of metastasis from a small cell carcinoma of the lung, where these tumors most commonly occur. The diagnostic utility of IHC in distinguishing NETs from various organ systems has been extensively studied.…”