Abstract
A 64-year-old man presented with abrupt hematemesis was transferred to the center with a diagnosis of upper gastrointestinal bleeding and hemorrhagic shock. After admission, an endoscopic examination revealed a type 2 lesion in the anterior wall of the stomach just under the cardiac part. Endoscopic hemostasis for bleeding from ulcer was unsuccessful, and a total gastrectomy was carried out. Intraoperative findings resulted in T3N1P0H0M0 in Stage IIIa. In the resected specimen, a IIa lesion in the posterior wall of the upper body of the stomach being independent from the type 2 lesion was confirmed by endoscpy. Histopathologically, diffuse proliferation of short spindle small cells with a high N/C ratio was noted for the type 2 lesion. On immunohistochemical stains, the lesion was positive for chromogranin A and epithelial membrane antigen. Electron microscopic examination revealed neuroendocrine cell. Based on these findings a diagnosis of small cell carcinoma of the stomach was made. The IIa lesion was well differentiated tubular adenocarcinoma. Small cell carcinoma of the stomach, especially that assocated with tubular adenocarcinoma is so rare that only two cases have been reported in both foreign and domestic literature.
