Department of Pathology, Shizuoka City Shimizu Hospital, 424-8636 Shizuoka, Japan.
World J Gastroenterol. 2011 Nov 21;17(43):4831-4. doi: 10.3748/wjg.v17.i43.4831.
A large cell neuroendocrine carcinoma (LCNEC) of the stomach is very rare. A 76-year-old Japanese man was admitted to our hospital because of epigastralgia and nausea. Endoscopy revealed 2 large tumors in the stomach. He did not have multiple endocrine neoplasia type I or Zollinger-Ellison syndrome. Imaging modalities, including computed tomography and magnetic resonance imaging, revealed no other tumors. Gastrectomy, cholecystectomy, and lymph node dissection were performed. The resected stomach had 2 tumors: one was an antral ulcerated type 3 tumor measuring 5 cm x 5 cm, and the other was a polypoid type 1 tumor measuring 6 cm x 6 cm x 3 cm in the fundus. Microscopically, the antral ulcerated tumor was a well differentiated adenocarcinoma with deep invasion. The fundus polypoid tumor was a LCNEC, being composed of malignant large cells arranged in trabecular and nested patterns. The tumor cells were large and the nuclei were vesicular. Nucleoli were frequently present, and there were many mitotic figures, apoptotic bodies, and necrotic areas. Much lymphovascular permeation was seen. Seven out of 29 dissected lymph nodes showed metastatic foci; 6 were from the LCNEC and 1 from the adenocarcinoma. Many intravascular tumor emboli of LCNEC were seen in the peritoneum around the lymph nodes. Mucins were present in the adenocarcinoma but not in the LCNEC. Immunohistochemically, the LCNEC tumor cells were positive for pancytokeratins, synaptophysin (50% positive), chromogranin A (10% positive), Ki-67 (90% labeled), and platelet-derived growth factor-α (80% positive). They were negative for KIT, p53, CD56, and neuron-specific enolase. The non-cancerous stomach showed a normal number of endocrine cells. The patient is now treated with adjuvant chemotherapy.
胃大细胞神经内分泌癌（LCNEC）非常罕见。一名 76 岁的日本男性因上腹痛和恶心而入院。内镜检查发现胃内有 2 个大肿瘤。他没有多发性内分泌肿瘤 1 型或 Zollinger-Ellison 综合征。包括计算机断层扫描和磁共振成像在内的影像学检查未发现其他肿瘤。进行了胃切除术、胆囊切除术和淋巴结清扫术。切除的胃有 2 个肿瘤：一个是 5 cm x 5 cm 的胃窦溃疡型 3 型肿瘤，另一个是 6 cm x 6 cm x 3 cm 的胃底部息肉样 1 型肿瘤。显微镜下，胃窦溃疡型肿瘤为分化良好的腺癌，浸润较深。胃底部息肉样肿瘤为 LCNEC，由排列成小梁和巢状的恶性大细胞组成。肿瘤细胞较大，核呈泡状。常可见核仁，有许多有丝分裂象、凋亡小体和坏死区。可见大量淋巴管浸润。29 个解剖淋巴结中有 7 个显示转移病灶；6 个来自 LCNEC，1 个来自腺癌。在淋巴结周围的腹膜中可见许多 LCNEC 的血管内肿瘤栓子。腺癌中存在粘蛋白，但 LCNEC 中不存在。免疫组化染色显示，LCNEC 肿瘤细胞对广谱细胞角蛋白、突触素（50%阳性）、嗜铬粒蛋白 A（10%阳性）、Ki-67（90%标记）和血小板衍生生长因子-α（80%阳性）阳性，而对 KIT、p53、CD56 和神经元特异性烯醇化酶阴性。非癌胃显示正常数量的内分泌细胞。患者目前正在接受辅助化疗。
