Gastric mixed adenoneuroendocrine carcinoma occurring 30 years after a gastroenterostomy

Mihaela Mădălina Gavrilescu, Ionuț Huțanu, Ana-Maria Mușină, Mihaela Buna-Arvinte, Ana Maria Patrașcu, Iulian Radu, Bogdan Filip, Maria Gabriela Aniței, Dragoș Viorel Scripcariu, Viorel Scripcariu


Gastroenteropancreatic neuroendocrine carcinomas (GEP-NENs) represent a heterogeneous group of rare tumors. The incidence of GEP-NENs has increased worldwide over the past decades, with the small intestine, rectum, and pancreas as the most common tumor locations. The epidemiological characteristics, pathogenesis and treatment have raised many questions, and some of them are still being debated. Here, we report a case of gastric collision tumor with large-cell neuroendocrine carcinoma and adenocarcinoma. A 73-year-old male patient with a history of gastric resection performed 30 years ago, with no medical records revealing the type of resection or the reconstructive way, presented with epigastric pain. The endoscopy revealed a solid, ulcerated mass at the gastrojejunal anastomosis site from which a tissue biopsy was taken, which was reported as adenocarcinoma. For staging, the patient underwent an abdominal CT scan, which showed the thickening of the gastric wall adjacent to anastomosis and perilesional adenopathy. The patient underwent a subtotal gastrectomy and regional lymphadenectomy. A diagnosis of large-cell neuroendocrine carcinoma developed on the gastric stump associated with isolated foci of moderately differentiated tubular adenocarcinoma pT3N1G3 was made. Immunohistochemical analysis is essential for the diagnosis and classification of the lesion. To confirm the diagnosis, Chromogranin A and Synaptophysin are needed, and for prognostic evaluation the identification of Ki-67 and mitotic figure count are required.


neuroendocrine tumor; gastric carcinoma; adenoneuroendocrine carcinoma; G-NET; surgery

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Rinzivillo M, Panzuto F, Delle Fave G. Controversies in the treatment of digestive neuroendocrine tumors. J Cancer Metasta Treat 2016; 2:304-309.

Schott M, Klöppel G, Raffel A, Saleh A, Knoefel WT, Scherbaum WA. Neuroendocrine neoplasms of the gastrointestinal tract. Dtsch Arztebl Int 2011; 108(18):305-312.

Rindi G, Klöppel G, Alhman H, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2006; 449(4):395-401.

Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system, 4th Edition. Lyon: IARC, 2010.

Hijioka S, Hosoda W, Mizuno N, et al. Does the WHO 2010 classification of pancreatic neuroendocrine neoplasms accurately characterize pancreatic neuroendocrine carcinomas? J Gastroenterol 2015; 50(5):564-572.

Aoyagi K, Kizaki J, Isobe T, Akagi Y. A case of gastric cancer with neuroendocrine carcinoma, signet ring cell carcinoma components, and intramural metastases. Am J Case Rep 2016; 17:274-279.

Düzköylü Y, Aras O, Bostancı EB, Keklik Temuçin T, Ulaş M. Mixed adeno-neuroendocrine carcinoma; case series of ten patients with review of the literature. Balkan Med J 2018; 35(3):263-267.

Sitarz R, Maciejewski R, Polkowski WP, Offerhaus GJ. Gastoroenterostoma after Billroth anterectomy as a premalignant condition. World J Gastroenterol 2012; 18(25):3201–3206.

Ishida M, Sekine S, Fukagawa T, et al. Neuroendocrine carcinoma of the stomach morphologic and immunohistochemical characteristics and prognosis. Am J Surg Pathol 2013; 37(7):949-959.

Fukuba NY, Takafumi I, Shunji S, et al. Gastric mixed adenoneuroendocrine carcinoma with a good prognosis. Inter med 2014; 53:2585-2588.

Dias AR, Azevedo BC, Alban LBV, et al. Gastric neuroendocrine tumor: review and update. Arq Bras Cir Dig 2017; 30(2):150-154.

Shen C, Chen H, Chen H, et al. Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience. BMC Gastroenterol 2016; 16:111.


Copyright (c) 2019 Mihaela Mădălina Gavrilescu, Ionuț Huțanu, Ana-Maria Mușină, Mihaela Buna-Arvinte, Ana Maria Patrașcu, Iulian Radu, Bogdan Filip, Maria Gabriela Aniței, Dragoș Viorel Scripcariu, Viorel Scripcariu

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