RESECTION OF GASTRIC ENDOCRINE CELL CARCINOMA THAT DEVELOPS RAPIDLY IN THE EXTRAMURAL AREA AND INFILTRATES THE LIVER-A CASE REPORT-

Abstract

The patient, a 68-year-old man, came to our hospital with a major complaint of discomfort in the upper abdominal region. Abdominal CT revealed a tumor with a diameter of about 8cm that had displaced the stomach, pancreatic tail, and hepatic lateral segment. An endoscopic examination of the upper digestive tract exhibited a submucosal tumor-like lesion with ulceration in part lesser extending from the lower part of the gastric body to the curvature of the upper stomach. Biopsy specimens collected from the periphery and bottom of the ulcerous lesion showed Group I and necrotic tissue respectively. From angiography, a darkly stained tumor with the left gastric artery acting as the major artery to supply nutrients was recognized. With a presurgical diagnosis of a gastrointestinal stromal tumor, surgery was conducted. The lesion had directly infiltrated the hepatic lateral segment and the patient was subjected to total gastrectomy, D1 lymph node dissection, and combined resection of the hepatic lateral segment. The histopathological examination revealed the following: HE stain showed that the tumor consisted of proliferating tumor foci of undifferentiated cells; and immunohistochemical staining exhibited positive reactions to Grimelius, neural cell adhesion molecules, and neuron-specific enolase, which led to a diagnosis of a gastric endocrine cell carcinoma. There has been no report on resection of gastric endocrine cell carcinoma with hepatic infiltration. The incidence is considered to be very rare.