Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2018; 24(4): 543-548
Published online Jan 28, 2018. doi: 10.3748/wjg.v24.i4.543
Neuroendocrine carcinoma of the gastric stump: A case report and literature review
Fu-Hai Ma, Li-Yan Xue, Ying-Tai Chen, Yi-Bin Xie, Yu-Xin Zhong, Quan Xu, Yan-Tao Tian
Fu-Hai Ma, Ying-Tai Chen, Yi-Bin Xie, Yu-Xin Zhong, Quan Xu, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Tian YT and Xue LY designed the report; Xie YB, Zhong YX and Xu Q collected the patient’s clinical data; Ma FH and Chen YT analyzed the data and wrote the paper.
Supported by Beijing Municipal Science and Technology Commission, No. 30224801; and National Natural Science Foundation of China, No. 81772647.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Beijing 100021, China. tyt67@163.com
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: November 10, 2017
Peer-review started: November 11, 2017
First decision: November 30, 2017
Revised: December 11, 2017
Accepted: December 20, 2017
Article in press: December 20, 2017
Published online: January 28, 2018
Abstract

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-year-old man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin (EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computed tomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first- and second-line settings. The patient died of disease progression 31 months after surgery.

Keywords: Gastric stump, Gastric stump cancer, Neuroendocrine carcinoma

Core tip: The most common form of gastric stump cancer is adenocarcinoma. Various types of malignancies have been reported previously, but the development of neuroendocrine carcinoma from the gastric stump is rare. This case might contribute to improving our understanding of the carcinogenesis, biology, and behavior of gastric neuroendocrine carcinoma and gastric stump cancer.