SYNCHRONOUS ADENOCARCINOMA AND STROMAL TUMOR OF THE STOMACH : A CASE REPORT

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SYNCHRONOUS ADENOCARCINOMA AND STROMAL TUMOR OF THE STOMACH : A CASE REPORT. NUNZIA SCIBETTA - LORENZO MARASA’ Department of Pathology, A.R.N.A.S. Civico, Palermo. INTRODUCTION. - PowerPoint PPT Presentation

Transcript of SYNCHRONOUS ADENOCARCINOMA AND STROMAL TUMOR OF THE STOMACH : A CASE REPORT

  • SYNCHRONOUS ADENOCARCINOMA AND STROMAL TUMOR OF THE STOMACH : A CASE REPORT.NUNZIA SCIBETTA - LORENZO MARASADepartment of Pathology, A.R.N.A.S. Civico, Palermo

  • INTRODUCTIONThe simultaneous development of gastric mesen-chymal tumor and adenocarcinoma has been rarely documented in the literature. The majority were reported in the Japanese literature and regard coexistent adenocarcinoma and leiomyo-ma or leiomyosarcoma of the stomach. Recently, Maiorana et al [2000] report 6 cases with syn-chronous occurrence of epithelial and stromal tumors in the stomach. We report a case of synchronous occurrence of ga-strointestinal stromal tumor (GIST) and adenocarcino-ma located in different regions of the stomach.

  • METHODSA 88-year-old woman , with nausea and abdominal di-scomfort was subjected to esophago-gastro-duodeno-scopy, that showed a polypoid mass located on the an-trum. On small biopsy fragments, a pathologic diagno-sis of adenocarcinoma was rendered. She no showed family history of cancer. Abdominal computed tomogra-phic scans and thoracic radiographs performed had di-sclosed no metastatic deposits.Partial gastrectomy was performed. Specimens had been fixed in 4% formaldehyde and embedded in para-plast. Sections were stained with H&E.Immunohistochemistry was performed using a panel of antibodies directed against the following antigens:EMA, vimentin, desmin, muscle-specific actin, S100 protein, CD34, CD117, KI 67.

  • RESULTSGrossly the stomach showed a polypoid, ulcerated mass of 5 cm of largest diameter located in the antrum, and a 0,5 cm, subserosal nodule, on section well-circumscribed, with smooth appearance, located in the lesser curvature.

    Microscopic examination revealed that the exophytic mass was an intestinal-type adenocarcinoma infiltrating the submucosa, and the subserosal nodule was a GIST with epithelioid cells, with clear cytoplasm and well-defined cell membranes.The non neoplastic gastric mucosa showed chronic gastritis.

  • 2 . Intestinaltype, gastric adenocar-cinoma: immunoreactivity for CKAE11223123231 . Intestinal-type, gastric adenocar- cinoma

  • 3 . Intramuscolar- subserosal gastric nodule 1223123234 . The tumor is composed of epithe-lioid cells with clear cytoplasm 34

  • IMMUNOHISTOCHEMICAL EXAMINATION Immunohistochemical reactions in the GIST were diffusely positive for CD34 and vimentin, focally positive for CD117, negative for EMA, S100 protein, desmin, muscle-specific actin. The mitoses were
  • CONCLUSIONSThis coexistence of epithelial and stromal gastric tumor raises the question of whether such an occurrence is a simple incidental association, or the 2 lesions are connected by a causal relationship. Gene mutations might underlie tumor predisposition in patients harbouring a double gastric neoplasia, at present, however, no data are available to support this hypothesis.A tumorigenic agent interacting with 2 neighboring tissues could produce development of tumors of different histotypes in the same organ and experimental evidence for this possibility has been provided.Investigating the molecular alterations in cases such as this one will possibly shed interesting light on the mechanism of tumorigenesis.

    MAIN REFERENCE Maiorana A. et al.- Arch Pathol Lab Med 124 : 682 686 ; 2000.