engleski

Composite glandular-endocrine cell carcinoma of the stomach

Composite glandular-endocrine cell carcinoma, also called adenocarcinoid, is recognized as a special type of gastric tumor composed of ordinary adenocarcinoma and neuroendocrine tumor. The existence of composite tumors poses nosologic, histogenic and diagnostic problems. Adenocarcinomas containing endocrine cells appear to be as biologically aggressive as the usual adenocarcinomas of the stomach. This type of tumor in the stomach is a very rare finding and, to our knowledge, there are only few reports in the literature, without specific numbers to describe its incidence. We report on a rare case of gastric collision tumor composed of adenocarcinoma and carcinoid. A 63-year-old-man complained of inappetence and weight loss within the previous 2 weeks, with nausea after meal and occasional vomiting. He had epigastralgia on pressure and while coughing. Physical examination showed icterus and 5 cm palpable liver. Laboratory findings revealed anemia, elevated liver enzymes and tumor markers (CEA, Ca 19-9, AFP, CA 15-3, CGA). Ultrasound of the abdomen showed multiple focal hyperechogenic areas of the liver, which seemed to be metastatic lesions. Gastroscopy demonstrated a large invasive ulcerative lesion of the gastric body and biopsy was performed. Histologic analysis revealed a tumor composed of atypical pseudoglandular areas lined with cytokeratin positive tumor cells. Partially within the stroma, aggregates of unimorphic cells with fine granulated chromatin, some of them forming acinar structures, were found. These structures expressed strong chromogranin and mild synaptophysin positivity. Small biopsy specimen in conclusion was interpreted as an aggressive adenocarcinoma partially formed of clusters of cells with prominent neuroendocrine component. The patient's serious health condition prevented any surgical treatment. Therefore, only small gastric biopsy specimen was analyzed. At this point, the importance of adequate gastroendoscopic biopsy and accurate analysis of the biopsy specimen considering its limited size should be emphasized.

adenocarcinoma; neuroendocrine tumor

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