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  • Concurrent occurrence of gastric adenocarcinoma and duodenal neuroendocrine cell carcinoma: a composite tumour or collision tumours ?

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Case reports
Concurrent occurrence of gastric adenocarcinoma and duodenal neuroendocrine cell carcinoma: a composite tumour or collision tumours ?
  1. H Fukuia,b,
  2. M Takadac,d,
  3. T Chibab,
  4. R Kashiwagic,
  5. M Sakanec,
  6. F Tabatac,
  7. Y Kurodad,
  8. Y Uedaa,
  9. H Kawamataa,
  10. J Imuraa,
  11. T Fujimoria
  1. aDepartment of Pathology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan, bDepartment of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan, cTabata Gastrointestinal Hospital, Akashi, Japan, dFirst Department of Surgery, Kobe University School of Medicine, Kobe, Japan, eH Fukui and M Takada contributed equally to this work.
  1. Dr T Fujimori, Department of Pathology, Dokkyo University School of Medicine, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan.t-fuji{at}dokkyomed.ac.jp

Abstract

BACKGROUND Neuroendocrine cell (NEC) carcinoma is occasionally accompanied by adenocarcinoma but the relationship between these two morphologically distinct tumours is unclear. Two hypotheses have arisen regarding the mechanism for the association of adenocarcinoma and NEC carcinoma. One is that both are derived from a common multipotential epithelial stem cell. The second hypothesis is that adenocarcinoma and NEC carcinoma arise from a multipotential epithelial stem cell and a primitive NEC, respectively.

AIMS To elucidate the relationship between the two histologically distinct tumours, adenocarcinoma of the stomach and NEC carcinoma of the duodenum.

PATIENT/METHODS We present a case in which the tumour extended across the pyloric ring, the gastric portion of which revealed adenocarcinoma while the duodenal portion showed argyrophil NEC carcinoma. The two histologically distinct lesions of the tumour were examined by immunohistochemistry and genetic analysis of p53.

RESULTS The gastric region was negative for chromogranin A staining but positive for carcinoembryonic antigen (CEA) staining. In contrast, the duodenal region was positive for chromogranin A but negative for CEA. All tumour regions showed a point mutation in p53 gene at exon 7 (GGC (glycine)→GTC (valine) at codon 245). The distal portion of the duodenal tumour showed an additional point mutation inp53 gene at exon 5 (GCC (alanine)→GTC (valine) at codon 129).

CONCLUSIONS The two histologically distinct tumours, adenocarcinoma of the stomach and NEC carcinoma of the duodenum, appear to be derived from a common epithelial cell.

  • neuroendocrine cell carcinomas
  • adenocarcinoma
  • composite tumour
  • collision tumours

  • Abbreviations used in this paper

    CEA
    carcinoembryonic antigen
    NEC
    neuroendocrine cell
    PCR-SSCP
    polymerase chain reaction-single stranded conformational polymorphism

    • https://doi.org/10.1136/gut.48.6.853

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    • Abbreviations used in this paper

      CEA
      carcinoembryonic antigen
      NEC
      neuroendocrine cell
      PCR-SSCP
      polymerase chain reaction-single stranded conformational polymorphism
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