Clin Endosc.  2019 May;52(3):278-282. 10.5946/ce.2018.114.

Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report

• Cha RR
• Cho JK
• Kim WS
• Kim JJ
• Lee JM
• Lee SS
• Kim HJ

• KMID: 2449770
• DOI: http://doi.org/10.5946/ce.2018.114

Abstract

Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.

Keyword

Extrapulmonary small cell carcinoma; Endosonography; Linitis plastica

MeSH Terms

Aged, 80 and over
Biopsy*
Carcinoma, Small Cell*
Diagnosis
Diagnosis, Differential
Endoscopy
Endosonography
Female
Humans
Linitis Plastica
Neuroendocrine Tumors
Plastics
Stomach
Stomach Neoplasms
Ultrasonography
Plastics

Figure

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  Fig. 1. Abdominal computed tomography showing diffuse thickening of the gastric wall extending from the body to the antrum (arrow).

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  Fig. 2. Positron emission tomography-computed tomography of the chest, abdomen, and pelvis showing fluorodeoxyglucose uptake along the gastric antrum and body (arrow), with a maximum standardized uptake value of 7.76.

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  Fig. 3. Esophagogastroduodenoscopy showing diffuse circumferential thickening and poor distension of the gastric walls from the antrum to the gastric body.

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  Fig. 4. Conventional endoscopic ultrasound (EUS) images. A gastric infiltrating tumor diagnosed using EUS (A, B). EUS showing homogeneous, slightly hypoechogenic thickening of the submucosal layer (12 mm) and intact muscularis propria layer shows reactive wall thickening (C, arrow). The thinnest part of the mucosal lesion was selected for the biopsy after EUS localization (D, arrow).

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  Fig. 5. Microscopic findings of the gastric tissue. Hematoxylin and eosin stained biopsy specimens show small tumor cells with irregular nuclei and scant cytoplasm (A). Tumor cells stained positive for cytokeratin (B) and CD56 (C), while they were negative for thyroid transcription factor-1 staining (D). Detection of a strong Ki-67 reactivity was observed (E). All the images were captured at ×200 magnification.

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