Abstract: Collision tumors are gastrointestinal tumors displaying both exocrine and Neuroendocrine (NE) differentiation. True collision tumors are defined as those in which NETs and conventional carcinomas are closely juxtaposed, but not admixed. These are well recognized, but very uncommon. Recently world health organization has renamed these as mixed Adenocarcinoma Neuroendocrine (MANECs). Gastric MANECs are rare and usually described to be composed of an exocrine component represented by an Adenocarcinoma with a variable grade of differentiation and a neuroendocrine component usually represented by a NEC. We present here a case which presented with dyspeptic symptoms and weight loss. The Esophagogastroduodenoscopy (EGD) revealed a mass at the cardiac end of stomach and at lesser curvature. Also a nodule was identified at the gastric antrum and in 1st part of duodenum. Endoscopic biopsy from cardiac end of stomach and lesser curvature showed features of Adenocarcinoma, while biopsy from nodule in gastric antrum and duodenum was diagnosed as Neuroendocrine carcinoma after confirmation with Immunohistochemistry (Synaptophysin and Chromogranin A.). Subtotal Gastrectomy showed multiple tumors in fundus, body and antrum of the stomach. Microscopy revealed poorly differentiated Adenocarcinoma – Stage: T2bNxMx and Neuroendocrine carcinoma G1. Two hypotheses have arisen to describe the histological origin. One is that are derived from a common multipotential epithelial stem cell, the NEC component resulting from differentiation from the Adenocarcinoma. The second is that Adenocarcinoma and NEC carcinoma arise from a multipotential epithelial stem cell and a primitive NEC, respectively. The clinical behavior of composite carcinomas depends on the poorly differentiated components. Treatment consists of excision of operable / curable tumors.
Keywords: mixed tumors of stomach; collision tumors; double tumors; Adenocarcinoma; Neuroendocrine carcinoma; MANEC tumors.
Title: Collision Tumor of the Stomach: Co-Existing Adenocarcinoma And Neuroendocrine Carcinoma: Managed Surgically
Author: Rajesh Dogra, Nina Furia, Harshad Jariwala, Pratik Jariwala, Leena Salunkhe, Kaushik Joshi
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
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