Nemoto Hiroshi, Tate Genshu, Yokomizo Kazuaki, Umemoto Takahiro, Matsubara Taketo, Mizukami Hiroki, Kigawa Gaku, Matsumiya Akihiko, Tanaka Junichi
Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Case Rep Oncol. 2014 May 21;7(2):330-6. doi: 10.1159/000363222. eCollection 2014 May.
A 75-year-old man was diagnosed with gastric cancer. Fifty years previously, he had undergone gastroenterostomy with a Braun enteroenterostomy. At present, a distal gastrectomy and small intestinal partial resection were performed. Intraoperatively, the tumor was localized to the previous stomal site. HE staining showed that the tumor comprised two elements: a tubular adenocarcinoma on the gastric side and a neuroendocrine carcinoma (NEC) on the jejunal side. The final pathologic diagnosis was mixed adenoneuroendocrine carcinoma based on an immunohistochemical analysis of endocrine markers and an elevated Ki-67 labeling index. The risk of later cancer development cancer recurrence near the gastrojejunostomy site is well known. Potentially, chronic enterogastric bile reflux may irritate the gastric mucosa and act as a promoter. Gastric NEC has a strong malignant potential. We suspect that, in the present case, the constant exposure to secondary bile may have induced a gastric mucosal adenocarcinoma, which finally differentiated into a NEC.
一名75岁男性被诊断为胃癌。50年前，他接受了胃空肠吻合术和布朗式肠肠吻合术。目前，进行了远端胃切除术和小肠部分切除术。术中发现肿瘤位于先前的吻合口部位。苏木精-伊红染色显示肿瘤由两种成分组成：胃侧的管状腺癌和空肠侧的神经内分泌癌（NEC）。根据内分泌标志物的免疫组化分析和升高的Ki-67标记指数，最终病理诊断为混合性腺神经内分泌癌。胃空肠吻合口附近后期癌症发生及癌症复发的风险是众所周知的。潜在地，慢性肠胃胆汁反流可能刺激胃黏膜并起到促癌作用。胃NEC具有很强的恶性潜能。我们怀疑，在本病例中，持续接触继发性胆汁可能诱发了胃黏膜腺癌，最终分化为NEC。
