ABSTRACT
We describe a case of gastric carcinoid and inflammatory fibroid polyp concomitant with a composite tumor of the gastric antrum composed of poorly differentiated adenocarcinoma - endocrine carcinoma with immunohistochemical documentation of endocrine and non endocrine differentiation in a 67-year-old man with atrophic gastritis and intestinal metaplasia. When gastrectomy was carried out, two lymph nodes along the greater curvature harbored metastasis from carcinoid. The same occurrence is reported in several cases in the literature, which suggests that the association of gastric carcinoid to adenocarcinoma could point to the malignant nature of carcinoid. Furthermore, the findings in this patient reinforce the concept that the epithelial and neuroendocrine cells of the gastrointestinal tract both result from multidirectional differentiation of a primitive cell.
Subject(s)
Adenocarcinoma/pathology , Carcinoid Tumor/pathology , Endocrine Gland Neoplasms/pathology , Gastritis, Atrophic/pathology , Polyps/pathology , Precancerous Conditions/pathology , Stomach Neoplasms/pathology , Adenocarcinoma/surgery , Aged , Carcinoid Tumor/surgery , Cell Differentiation , Endocrine Gland Neoplasms/surgery , Gastrectomy , Gastritis, Atrophic/surgery , Humans , Immunohistochemistry , Lymphatic Metastasis , Male , Metaplasia , Polyps/surgery , Precancerous Conditions/surgery , Stomach Neoplasms/surgery , Treatment OutcomeABSTRACT
Glomus tumors are relatively uncommon benign neoplasms, most common in the skin and subcutaneous tissue, but can also occur in the viscera, most often in the stomach. Preoperative diagnosis, when the tumor occurs in the stomach, seems difficult but is important, since glomus tumors of the stomach are essentially benign and amenable to conservative excision, contrary to aggressive gastric neoplasms. We describe the case of a 75-year-old man presented to the emergency department with gastrointestinal bleeding and epigastric pain. Gastroscopy revealed a submucosal mass in the antrum of the stomach in correspondence to the lesser curvature. Biopsies taken from the lesion showed morphological and immunohistochemical [positivity for alphasmooth muscle actin (alpha-SMA) and vimentin, negativity for CD34, CD117, chromogranin, synaptophysin, desmin and S-100 protein] characteristics attributable to glomus tumor. The patient underwent a laparotomic antrotomy incision. Histological examination of the tumor confirmed the diagnosis of gastric glomus tumor.