J Gastric Cancer.  2016 Dec;16(4):266-270. 10.5230/jgc.2016.16.4.266.

A Concurrence of Adenocarcinoma with Micropapillary Features and Composite Glandular-Endocrine Cell Carcinoma in the Stomach

• Kim JH
• Eom DW
• Park CS
• Kwak JY
• Park EH
• Kwak JH
• Jang HJ
• Choi KM
• Han MS

• KMID: 2389853
• DOI: http://doi.org/10.5230/jgc.2016.16.4.266

Abstract

We report a unique case of synchronous double primary gastric cancer consisting of adenocarcinoma components with micropapillary features and composite glandular-endocrine cell carcinoma components. The patient was a 53-year-old man presenting with a 6-month history of epigastric pain and diarrhea. A subtotal gastrectomy was performed. Histologically, one tumor was composed of micropapillary carcinoma components (50%) with tight clusters of micropapillary aggregates lying in the empty spaces, admixed with moderately differentiated adenocarcinoma components. MUC-1 was expressed at the stromal edge of the micropapillary component. The other tumor was composed of atypical carcinoid-like neuroendocrine carcinoma (50%), adenocarcinoid (30%), and adenocarcinoma components (20%). The neuroendocrine components were positive for CD56, synaptophysin, chromogranin, and creatine kinase. The adenocarcinoid components were positive for both carcinoembryonic antigen and neuroendocrine markers (amphicrine differentiation). This case is unique, due to the peculiar histologic micropapillary pattern and the histologic spectrum of adenocarcinoma adenocarcinoid-neuroendocrine carcinoma of the synchronous composite tumor.

Keyword

Gastrectomy; Neoplasm; Multiple primary; Synchronous; Stomach

MeSH Terms

Adenocarcinoma*
Carcinoembryonic Antigen
Carcinoma, Neuroendocrine
Creatine Kinase
Deception
Diarrhea
Gastrectomy
Humans
Middle Aged
Stomach Neoplasms
Stomach*
Synaptophysin
Carcinoembryonic Antigen
Creatine Kinase
Synaptophysin

Figure

• 

  Fig. 1 A subtotal gastrectomy specimen showing two well defined tumors. An ulceroinfiltrative tumor (A; 3.5×3.0×0.5 cm) present in the posterior wall of the antrum. The other tumor in the anterior wall of the antrum (B; 3.0×2.8×0.8 cm).

• 

  Fig. 2 (A, B) The larger tumor was composed of an invasive micropapillary carcinoma component admixed with moderately differentiated adenocarcinoma components (H&E; A: ×40, B: ×100). (C) MUC-1 expression at the stromal edges of small clusters of the micropapillary carcinoma (immunohistochemistry stain, ×200). (D) Negative D2-40 expression in the lining epithelium of the empty space of the tumor (immunohistochemistry stain, ×200).

• 

  Fig. 3 (A, B) An intermixed area of the adenocarcinoma and goblet cell carcinoid (H&E, ×200). (C) Neuroendocrine cell carcinoma (right side) components adjacent to the adenocarcinoma components (H&E, ×100). (D) Goblet cell or tubular carcinoid (H&E, ×100).

• 

  Fig. 4 (A) Chromogranin as expressed in the adenocarcinoid components, but not in the adenocarcinoma cells. (B) Carcinoembryonic antigen (CEA) staining positive in the adenocarcinoma, but negative in the neuroendocrine components. (C) Adenocarcinoid cells were diffusely positive for CEA, but intermixed neuroendocrine carcinoma cells were negative (A~C: immunohistochemistry stain, ×200).

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