Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan.
Watanabe's Consultancy for Pathological Diagnosis, 1007 Surpass Sakurada-cho Ichibankan 3-30-1 Sakurada-cho, Kanazawa, Ishikawa, 920-0057, Japan.
Diagn Pathol. 2021 Feb 2;16(1):11. doi: 10.1186/s13000-021-01070-x.
The majority of gastrointestinal tumors are adenocarcinomas. Rarely, there are other types of tumors, such as acinar cell carcinoma, and these are often called pancreatic-type acinar cell carcinomas. Among these tumors, some are differentiated into neuroendocrine components. A few of them are MiNENs.
The patient was an 80-year-old male who was referred to our hospital for treatment of a pedunculated gastric tumor. It was 5 cm in diameter and detected in the upper gastric body with upper GI endoscopy conducted to investigate anemia. In the biopsy, although hyperplasia of gastric gland cells was noted, no tumor cells were found. Retrospectively, the diagnosis was misdiagnosed. An operation was arranged because bleeding from the tumor was suspected as a cause of anemia and because surgical resection was considered to be desirable for accurate diagnosis. Hence, laparoscopic and endoscopic cooperative surgery was performed. In the pathological examination, several types of epithelial cells that proliferated in the area between the mucosa and deep inside the submucosa were observed. These consisted of acinar-glandular/trabecular patterns and solid. A diagnosis of pancreatic-type acinar cell carcinoma of the stomach with NET G2 and G3 was made based on characteristic cellular findings and the results of immunostaining tests. Each of them consisted of more than 30% of the lesion; a diagnosis of pancreatic-type mixed acinar neuroendocrine carcinoma (pancreatic-type MiNEN) of the stomach or a type of gastric MiNEN was obtained. Anemia was resolved after the operation, and the patient was discharged from the hospital without perioperative complications.
Pancreatic-type ACC of the stomach that is differentiated into neuroendocrine tumors is very rare. Hence, we report this case along with a literature review.
大多数胃肠道肿瘤为腺癌。罕见情况下，还有其他类型的肿瘤，如腺泡细胞癌，这些通常被称为胰腺型腺泡细胞癌。在这些肿瘤中，有些分化为神经内分泌成分。其中少数为 MiNENs。
患者为 80 岁男性，因治疗带蒂胃肿瘤而被转至我院。肿瘤直径为 5cm，在上胃部通过上消化道内镜检查发现，以调查贫血原因。在活检中，虽然注意到胃腺细胞增生，但未发现肿瘤细胞。回顾性诊断为误诊。由于怀疑肿瘤出血是贫血的原因，且考虑到手术切除对明确诊断是理想的，故安排了手术。因此，进行了腹腔镜和内镜联合手术。在病理检查中，观察到在黏膜和黏膜下层深部之间增殖的几种上皮细胞。这些细胞包括腺泡-腺管/小梁模式和实性。根据特征性细胞发现和免疫染色试验结果，诊断为胃胰腺型腺泡细胞癌伴 NET G2 和 G3。它们中的每一个都占病变的 30%以上；诊断为胃胰腺型混合腺泡神经内分泌癌（胰腺型 MiNEN）或胃 MiNEN 类型。手术后贫血得到解决，患者无围手术期并发症出院。
胃胰腺型 ACC 分化为神经内分泌肿瘤非常罕见。因此，我们报告了这一病例，并进行了文献复习。
