Case Report
Copyright ©The Author(s) 2020.
World J Gastroenterol. Dec 7, 2020; 26(45): 7263-7271
Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7263
Figure 1
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Figure 1 Abdominal contrast-enhanced computed tomography images. A: Wall thickness from the esophagogastric junction to the cardia (yellow arrowhead) and enlarged lymph nodes near the lesser curvature of the stomach (orange arrow); B: Multiple ring-enhanced tumors are observed in the liver.
Figure 2
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Figure 2 Esophagogastroduodenoscopy revealed type 3 tumor located from the esophagogastric junction to the cardia. A: Image from endoscopic examination of esophagus; B: Image from endoscopic examination of stomach.
Figure 3
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Figure 3 Histological findings of a mucosal lesion. A: Low-power histological view of Hematoxylin and eosin (H-E) stained specimens showing atypical epithelial cells with solid alveolar nests; B: High-power view of H-E stained specimens reveals poorly differentiated atypical cells with large nucleus-cytoplasm ratio; C: Synaptophysin positive; D: Ki 67 index is approximately 70%; E: CD56 positive; F: Chromogranin A positive.
Figure 4
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Figure 4 Clinical course of this case. A-D: Serum tumor markers were elevated. A CT scan after seven courses of chemotherapy revealed increased liver metastasis. CDDP: Cisplatin; CPT-11: Irinotecan; RAM: Ramucirumab; nab-PTX: Nab-Paclitaxel; NIVO: Nivolumab; SOX: S-1 and oxaliplatin; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; NSE: Neuron-specific enolase; Pro-GRP: Pro-gastrin-releasing peptide.
Figure 5
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Figure 5 Diagram showing that the mammalian target of rapamycin inhibitor suppresses the formation of neuroendocrine tumor by suppressing the AKT-mTOR pathway. In the AKT-mTOR pathway, mutation of tuberous sclerosis complex (TSC)1/TSC2 genes causes mTOR to proliferate and generate neuroendocrine tumor (NET). Sirolimus, an mTOR inhibitor, inhibits the abnormal growth of mTOR, which suppresses the generation of NET. TSC: Tuberous sclerosis complex; AMPK: Adenosine 5'-monophosphate (AMP)-activated protein kinase; ERK: Extracellular regulated protein kinases; RSK: Ribosomal S6 kinase; EBP: Evidence-based practice; NET: Neuroendocrine tumor.