Primary small cell carcinoma of the stomach.
We report on an 80-year-old man with primary gastric small cell carcinoma (SmCC). He was admitted to hospital with hematemesis. An upper gastrointestinal examination revealed an irregularly ulcerated tumor, 60 mm in diameter, on the lesser curvature of the stomach body extending to the cardia. An endoscopic biopsy revealed a solid proliferation of intermediate-sized tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for neuron-specific enolase and chromogranin A, but negative for carcinoembryonic antigen. No tumor was detected on examination of the chest. Therefore, primary gastric SmCC was diagnosed preoperatively. To date, only 38 cases of primary gastric SmCC, including our case, have been reported. By using endoscopic biopsy, approximately two-thirds of cases have been diagnosed incorrectly. In the reported cases of gastric SmCC, the endoscopic findings frequently indicated a submucosal tumor. Gastric SmCC is clinically aggressive and has an extremely poor prognosis, even when discovered at an early stage. Most patients with gastric SmCC die within 1 year of diagnosis. Although a standard treatment for gastric SmCC has not been established, intensive chemotherapy should be considered to promote long-term survival. We believe that careful examination, including immunohistochemical investigation, is necessary for determining the therapeutic strategy whenever gastric SmCC is suspected during endoscopy.
Kusayanagi
Satoshi
S
Second Department of Internal Medicine, Showa University School of Medicine, Showa University Hospital, Tokyo, Japan.
Konishi
Kazuo
K
Miyasaka
Nobuo
N
Sasaki
Katsumi
K
Kurahashi
Toshinori
T
Kaneko
Kazuhiro
K
Akita
Yasushi
Y
Yoshikawa
Nozomi
N
Kusano
Mitsuo
M
Yamochi
Toshiko
T
Kushima
Miki
M
Mitamura
Keiji
K
D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D001706:Biopsy; D002272:Carcinoembryonic Antigen; D018288:Carcinoma, Small Cell / Q000175:diagnosis* / Q000473:pathology; D053379:Chromogranin A; D002864:Chromogranins; D016099:Endoscopy, Gastrointestinal; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D010751:Phosphopyruvate Hydratase; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053379:Chromogranin A; D002864:Chromogranins; D010751:Phosphopyruvate Hydratase