Abstract
A 72-year-old man who had undergone distal gastrectomy and Billroth-I reconstruction for early gastric cancer at 58 years old was judged to require further examination in a gastric cancer screening. Upper gastrointestinal endoscopy performed at our hospital showed an elevated lesion at the esophagogastric junction, a 0-IIa lesion on the proximal side of the gastroduodenostomy site, and ulcerative scarring in the posterior wall of the cardiac greater curvature. Biopsy results were por2, tub1, and no malignant findings, respectively. Simultaneous carcinomas in the gastric remnant were diagnosed, and total resection of the gastric remnant and Roux-en-Y reconstruction were performed. Immunohistochemical staining showed that the elevated lesion at the esophagogastric junction was positive for synaptophysin and CD56, with Ki-67 at 48%, and 9 mitotic figures per 10 high power fields, and based on these findings, neuroendocrine carcinoma was diagnosed. Neuroendocrine carcinoma occurring simultaneously with differentiated tubular adenocarcinoma in the gastric remnant and detected in the early stage of cancer is very rare. Along with a discussion of the literature, we report on our experience with this case in which preoperative diagnosis was difficult, and in which the small number of accumulated cases made it difficult to decide the treatment strategy.
