A Case of Effective Multidisciplinary Therapy for Gastric Endocrine Carcinoma with Bulky Metastatic Lymph Nodes

Abstract

A 73-year-old man who was admitted to our hospital to investigate the cause of anemia was diagnosed with gastric adenocarcinoma through a biopsy of a tumor at the lesser curvature of the gastric body using gastroscopy. Abdominal computed tomography (CT) scan showed bulky metastatic lymph nodes at the lesser curvature of the stomach with no evidence of distant metastasis. He received two courses of combined neoadjuvant chemotherapy with S-1 plus cisplatin. The bulky lymph nodes were reduced remarkably, and he underwent total gastrectomy and cholecystectomy. The pathological diagnosis was gastric endocrine cell carcinoma, ypT3(SS), ypN0, M0, ypStage IIA. According to the treatment guideline for small cell lung cancer, two courses of adjuvant chemotherapy with irinotecan plus cisplatin were added. He also received S-1 orally due to elevation of a tumor marker 6 months after the surgery. The tumor marker levels fell to the normal range. The patient remains alive without recurrence as of 21 months after the diagnosis. Gastric endocrine carcinoma is rare, so that no effective therapy has been established and the prognosis is poor. Multidisciplinary therapy including pre- and post-operative chemotherapy was considered to be effective in this case.