A Case of Gastric Neuroendocrine Carcinoma for which Bridge to Surgery by Endoscopic Stent Placement was Effective for Gastroduodenal Stenosis during Preoperative Chemotherapy

Abstract

A 53-year-old woman underwent upper-gastrointestinal endoscopy for epigastralgia that reveled a circumferentially growing type 3 tumor, extending from the antrum to duodenal bulb. A biopsy specimen confirmed small-cell neuroendocrine carcinoma. An abdominal computed tomography with contrast showed the thickening of the antrum and duodenal wall which has contact with the liver, and a number of bulky swollen lymph nodes (LNs). From these findings, she was diagnosed with gastric small-cell neuroendocrine carcinoma, T4bN3aM0, cStage III. The patient underwent chemotherapy with cisplatin and irinotecan (IP). After 1 course, gastroduodenal stenosis had occurred. Gastroduodenal stent placement was performed, and passage obstruction improved promptly. After 2 courses, an abdominal CT scan revealed a reduction in size of the primary tumor and LNs which reduced to 49% of the original mass. We performed radical distal gastrectomy with D2 plus no.17 lymph node dissection and Roux-en-Y reconstruction. The histopathological diagnosis was gastric small cell neuroendocrine carcinoma, ypT3(SS), ypN2, ypM0, ypStage IIIA. The efficacy of the chemotherapy was rated Grade 1b. After having received chemotherapy with IP for 6 months, she has no signs of tumor recurrence as of 20 months after the surgery.