J Gastric Cancer.  2011 Jun;11(2):126-130.

Composite Neuroendocrine Carcinoma with Adenocarcinoma of the Stomach Misdiagnosed as a Giant Submucosal Tumor

• Kim TY
• Chae HD

Abstract

A composite glandular/exocrine-endocrine carcinoma of the gastrointestinal tract is characterized by the co-existence of two adjacent, but histologically-distinct tumors in an organ. Composite glandular/exocrine-endocrine carcinomas are a special type of tumor comprised of common adenocarcinomas and neuroendocrine components that account for at least one-third of the entire tumor area. Composite tumors have been reported in a range of organs, but are relatively rare in the stomach. We report a case of a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach (mixed exocrine-endocrine carcinoma), which was misdiagnosed as a giant submucosal tumor preoperatively based on esophagogastroduodenoscopy and a contrast-enhanced axial computed tomographic scan.

Keyword

Composite tumor; Stomach; Submucosal tumor

MeSH Terms

Adenocarcinoma
Carcinoma, Neuroendocrine
Endoscopy, Digestive System
Gastrointestinal Tract
Stomach

Figure

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  Fig. 1 Gastroduodenoscopy shows a huge, well-defined fungating submucosal mass, measuring 10 cm in its largest dimension with eccentric ulceration and an ill-defined margin in the gastric antrum, lesser curvature.

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  Fig. 2 Preoperative contrast-enhanced axial CT scan shows a huge, solid, ovoid, heterogenous and exophytic mass measuring approximately 15×10 cm in the prepyloric antrum of the stomach.

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  Fig. 3 The tumor is composed of conventional adenocarcinoma with anaplastic glandular nests (arrow) and neuroendocrine carcinoma with central necrosis (arrow head) (H&E, ×100).

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  Fig. 4 Neuroendocrine carcinoma components show strong immunopositivity for chromogranin A (left upper), but negative immunostaining of adenocarcinoma component (right lower) (Immunohistochemical stain, ×200).

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