Mixed Adenoneuroendocrine Gastric Carcinoma: A Case Report and Review of the Literature
A 77-year-old Caucasian woman was admitted to our department with nausea, anorexia, weight loss, and anemia. The medical history of the patient did not include any significant prior illness. The findings of physical examination were unremarkable. The patient's hemoglobin level (10.3 g/dl) and tumor marker levels (carcinoembryonic antigen, carbohydrate antigen 19.9, and carbohydrate antigen 72-4) were within the normal range. Esophagogastroduodenoscopy revealed a large (>7 cm) ulcerative mass (Borrmann type 3) in the greater curvature of the stomach. Biopsy showed the presence of an adenocarcinoma with moderate differentiation. Computed tomography did not show distant metastasis. The patient underwent D2 subtotal gastrectomy, with no surgical complications. Histopathological analysis showed, in agreement with the diagnosis of a mixed gastric adenoneuroendocrine carcinoma (), that 30% of the tumor area was intensely positive for chromogranin () and synaptophysin (), with part of it being tubular adenocarcinoma (G2) and of the rest being neuroendocrine large cell carcinoma (G3). The tumor penetrated the serosa, but none of the 29 regional lymph nodes showed metastasis and no distant metastasis was detected (pT4a, pN0, pM0, stage IIb according to the 7th edition of the American Joint Committee on Cancer TNM classification). The lymphatic and vascular lumina were not invaded, but perineural invasion was present. The post-operative course was uneventful. The patient underwent adjuvant chemotherapy, consisting of a combination of cisplatin, doxorubicin, and vincristine, and at the 6-month follow-up, the patient was alive without evidence of recurrence.