A Case of Gastric Adenocarcinoma Developed in Neuroendocrine Carcinoma after Chemotherapy

Seong-Uk Lim; Seong-Rye Seo; Ju-Young Yoon; Dae-Ho Cho; Soo-Young Bae; Woo-Kyun Bae; Hyun-Jeong Shim; Sang-hee Cho; Ik-Joo Chung

doi:10.4068/cmj.2008.44.3.188

Journal List > Chonnam Med J > v.44(3) > 1017895

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Lim, Seo, Yoon, Cho, Bae, Bae, Shim, Cho, and Chung: A Case of Gastric Adenocarcinoma Developed in Neuroendocrine Carcinoma after Chemotherapy

Case Report

Chonnam Medical Journal

Chonnam Medical Journal 2008; 44(3): 188-193.

Published online: 18 December 2008

DOI: https://doi.org/10.4068/cmj.2008.44.3.188

A Case of Gastric Adenocarcinoma Developed in Neuroendocrine Carcinoma after Chemotherapy

Seong-Uk Lim, Seong-Rye Seo, Ju-Young Yoon, Dae-Ho Cho, Soo-Young Bae, Woo-Kyun Bae, Hyun-Jeong Shim, Sang-hee Cho, Ik-Joo Chung

Division of Hematology-Oncology, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author (shcho@chonnam.ac.kr)

Accepted 3 August 2008

Abstract

A 69-year-old male visited our medical center with hematemesis. Gastrofibroscopy revealed a 4.5 cm sized fungating mass on anterior wall of gastric lower body. Biopsy specimens showed a carcinoma of neuroendocrine components with strong positive for synaptophysin stain. Because he had a metastatic neuroendocrine carcinoma with multiple metastasis of liver, we treated him with chemotherapy of etoposide and cisplatin. The primary lesion showed nearly complete response after 6th cycles of chemotherapy, however it was regrowed with chemoresistance and mutifocal lesion in stomach and liver. Endoscopic biopsy on same previous lesion revealed a poorly differentiated tubular adenocarcinoma with negative for synaptophysin. After conversion to another tumor type, the treatment outcome was progressed in spite of salvage chemotherapy for gastric adenocarcinoma. He died 17 months after diagnosis. The immunohistological change of same mass after chemotherapy suggests a possibility of other course of differentiation from common pleuripotent cells of adenocarcinoma and neuroendocrine carcinoma after chemotherapy.

Keywords: Stomach, Carcinoma, Neuroendocrine, Adenocarcinoma

Figures and Tables

Fig. 1

Endoscopic finding. (A) Anterior wall side of gastric lower body shows a 4-5 cm sized large protruding submucosal mass-like lesion with exudates and exposed vessels at diagnosis. (B) The mass of same lesion shows dramatic regression after 3rd EP chemotherapy. (C) Anterior wall side of gastric upper body shows a new ulcerative lesion after 9th EP chemotherapy. (D) The same lesion shows a 7 cm sized aggressive mass with multiple ulceration and exudate at 15 momths from diagnosis.

Fig. 2

The histology at diagnosis revealed relatively smaller tumor cells with granular cytoplasm, centrally located round nuclei (A, hematoxylin&eosin staining, ×100) and strong positive for synaptophysin (B, ×400). After 9th EP chemotherapy, it showed a neoplasm with a poorly differentiated conventional glandular carcinoma (C, hematoxylin&eosin staining, ×100) and negative for synaptophysin (D, ×400).

Fig. 3

(A) CT finding shows a 3.4 cm sized biggest metastatic lesion (arrow) located in Rt. lobe of liver at diagnosis. (B) PET finding shows four metastatic lesions of liver in both lobe of liver at diagnosis. (C) It shows almost regression of the same biggest lesion (arrow) in liver during 1st line EP regimen. (D) It shows a progressed lesion with another feature in same location of previously shown mass (arrow) at 15 months from diagnosis.

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