Department of Pathology, Institute for Medical Science, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju-city, Jeonbuk 561-180, South Korea.
Pathol Res Pract. 2010 Jun 15;206(6):387-90. doi: 10.1016/j.prp.2009.09.003. Epub 2009 Nov 27.
Large cell neuroendocrine carcinomas (LCNECs) of the stomach are rare and represent only a small percentage of all gastric endocrine tumors. Here we report a case of a rare combination of gastric LCNEC concurrent with gastric adenocarcinoma. A 50-year-old man presented with heartburn sensation for 2 weeks. An endoscopic evaluation revealed a relatively well-demarcated ulcerative elevated lesion at the lower body of the stomach. Grossly, the gastric mass was a 5x4.5 cm-sized ulcerative fungating lesion. Microscopically, two separated lesions were recognized. The main lesion showed neuroendocrine morphology, such as nests and trabeculae. Most of the tumor cells had large, vesicular nuclei with prominent eosinophilic nucleoli, variable amounts of eosinophilic cytoplasm, and immunoreactivity for synaptophysin and chromogranin A. The other lesion was a well-differentiated adenocarcinoma of early gastric cancer type IIa located adjacent mucosa of the main lesion. We diagnosed this lesion as gastric LCNEC concurrent with focal adenocarcinoma, collision type.
胃大细胞神经内分泌癌（LCNEC）较为罕见，仅占所有胃内分泌肿瘤的一小部分。本文报道了一例罕见的胃 LCNEC 合并胃腺癌的病例。一名 50 岁男性因烧心感就诊 2 周。内镜评估显示胃体下部有一处界限清楚的溃疡性隆起性病变。大体上，胃肿块为 5x4.5cm 大小的溃疡性蕈伞状病变。镜下，识别出两个分开的病变。主要病变表现为神经内分泌形态，如巢状和小梁状。大多数肿瘤细胞具有大的、泡状核，伴明显嗜酸性核仁，嗜酸性细胞质的量不等，并对突触素和嗜铬粒 A 免疫反应阳性。另一个病变是位于主要病变相邻黏膜的早期胃癌 IIa 型分化良好的腺癌。我们诊断该病变为胃 LCNEC 合并局灶性腺癌，碰撞型。
