A Case of Small Cell Carcinoma of the Stomach with a Possibility of Transformation from Tubular Adenocarcinoma.

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  • 腺癌から発生したと考えられた胃小細胞癌の１例

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Abstract

A 74-year-old woman was seen at the hospital because of heart burn. Upper gastrointestinal endoscopy revealed an irregularly depressed reddish lesion in the lesser cuverture of the lower body of the stomach. Biopsy of the lesion showed moderately differentiated tubular adenocarcinoma. Distal gastrectomy and lymph node dissection were performed in June 1999. Resected specimens revealed a depressed lesion measuring 43×35mm in the lower body of the stomach. Histopathologically, the tumor was identified as combined carcinoma. The greater part consisted of well differentiated tubular adenocarcinoma. In the central part of the tumor, however, small and round cells proliferated with severe atypia, hyperchromatic nucleus, scanty cytoplasm, and frequent mitosis. Positive immunoreactivity for chromogranin A and a positive reaction on argyrophilic staining were compatible with small cell carcinoma. The area of small cell carcinoma massively invaded the submucosal layer.<br> In this case, small cell carcinoma was present in the central deepest part of the tumor surrounded by well differentiated tubular adenocarcinoma concomitantly. Two types of cancer cells were mixed together at the border area. It suggests a possibility that small cell carcinoma was transformed from well differentiated tubular adenocarcinoma.

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