Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Neuroendocrine Carcinoma Presenting as a Subepithelial Tumor Diagnosed by ESD

내시경 점막하 박리술로 진단된 상피하종양으로 발현한 위신경내분비암 1예

  • Baek, Dae-Hyun (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Kim, Seong-Hwan (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Jung, Jun-Young (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Son, Byoung-Kwan (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Jo, Yun-Ju (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Park, Young-Sook (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Lee, Won-Mi (Department of Pathology, Eulji University College of Medicine)
  • 백대현 (을지대학교 의과대학 내과학교실) ;
  • 김성환 (을지대학교 의과대학 내과학교실) ;
  • 정준영 (을지대학교 의과대학 내과학교실) ;
  • 손병관 (을지대학교 의과대학 내과학교실) ;
  • 조윤주 (을지대학교 의과대학 내과학교실) ;
  • 박영숙 (을지대학교 의과대학 내과학교실) ;
  • 이원미 (을지대학교 의과대학 병리학교실)
  • Published : 2011.04.30
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Abstract

A gastric neuroendocrine carcinoma is very rare, and the histological diagnosis is very difficult. These carcinomas result in a poor prognosis because they are preceded by severe lymphovascular invasion and early metastasis. In particular, it is difficult to distinguish between adenocarcinoma and neuroendocrine carcinoma by endoscopy when no specific symptoms are present (e.g., dyspepsia, nausea). According to published articles in Korea, most cases were diagnosed as adenocarcinoma initially; however, they were confirmed postoperatively as neuroendocrine carcinoma based on a histological examination using immunohistochemical staining. A case of a 55-year-old man, who had an incidental finding of a subepithelial tumor during his health check-up, was recommended for an endoscopic submucosal dissection (ESD). But the patient was lost to follow-up for 4 years. When he was examined again, the size of the tumor had increased from the previous exam. He underwent ESD and was diagnosed with a well-differentiated neuroendocrine carcinoma.

위에서 발생하는 신경 내분비 암은 매우 드물며 진단하기 쉽지가 않다. 상대적으로 맥관의 침윤도가 높고 조기 전이 소견을 보여 예후도 좋지 않다. 특히 소화불량이나 오심 등의 비특이적 증상뿐 아니라 내시경 검사 소견에서도 선암과의 구별이 쉽지않다. 국내에서 보고된 증례들의 경우, 대부분 선암으로 진단된 뒤 수술후 생검된 조직검사 및 면역화학 염색 검사 결과를 통해 진단되었다. 저자는 55세의 남자가 건강검진에서 우연히 상피하종양이 발견되어 내시경 점막하 박리술을 권유 받은 후 추적 소실되었고 4년 후 상부위장관 내시경 검사에서 종양의 크기 증가로 인하여 내시경 점막하 박리술을 받고 고분화 신경내분비암으로 진단된 증례를 경험하여 고찰과 함께 보고한다.

Keywords

References

  1. Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-959. https://doi.org/10.1002/cncr.11105
  2. Fukui H, Takada M, Chiba T, et al. Concurrent occurrence of gastric adenocarcinoma and duodenal neuroendocrine cell carcinoma: a composite tumour or collision tumour? Gut 2001;48:853-856. https://doi.org/10.1136/gut.48.6.853
  3. Kloppel G, Perren A, Heitz PU. The gastropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann N Y Acad Sci 2004;1014:13-27. https://doi.org/10.1196/annals.1294.002
  4. Godwin JD 2nd. Carcinoid tumors. An analysis of 2,837 cases. Cancer 1975;36:560-569. https://doi.org/10.1002/1097-0142(197508)36:2<560::AID-CNCR2820360235>3.0.CO;2-4
  5. Chaudhary UB, Taksey JD, Johnson RD, Lewin DN. Small-cell cancers, and unusual reaction to chemotherapy: Case 3. Small-cell carcinoma of the stomach. J Clin Oncol 2003;21: 2441-2442. https://doi.org/10.1200/JCO.2003.06.165
  6. Park YA, Cheong JH, Hyung WJ, Kim JU, Noh SH. Neuroendocrine carcinoma of the stomach. J Korean Surg Soc 2003;65:522-527.
  7. Shin DG, Kim BS, Jang SJ, et al. Neuroendocrine carcinoma of the stomach: a clinicopathologic study of 18 cases. J Korean Gastric Cancer Assoc 2003;3:191-194. https://doi.org/10.5230/jkgca.2003.3.4.191
  8. Kwon JG, Kim EY, Kim YS, et al. Accuracy of endoscopic ultrasonographic impression compared with pathologic diagnosis in gastrointestinal submucosal tumors. Korean J Gastroenterol 2005;45:88-96.
  9. Won TK, Kim EY, Seo CJ, et al. Endoscopic ultrasonogrphy in upper gastrointestinal subepithelial lesions. Korean J Gastrointest Endosc 2006;32:313-319.
  10. Rindi G. Clinicopathologic aspects of gastric neuroendocrine tumors. Am J Surg Pathol 1995;19(suppl 1):20S-29S.
  11. Xiaogang Z, Xingtao J, Huasheng W, Mo W. Atypical carcinoid of the esophagus: report of a case. Ann Thorac Cardiovasc Surg 2002;8:302-305.
  12. Sweeney EC, McDonnell LM. Atypical gastric carcinoids. Histpathology 1980;4:215-224. https://doi.org/10.1111/j.1365-2559.1980.tb02914.x
  13. Matsui K, Jin XM, Kitagawa M, Miwa A. Clinicopathologic features of neuroendocrine carcinomas of the stomach: appraisal of small cell and large cell variants. Arch Pathol Lab Med 1998;122:1010-1017.
  14. Boo YJ, Park SS, Kim JH, Mok YJ, Kim SJ, Kim CS. Gastric neuroendocrine carcinoma: clinicopathologic review and immunohistochemical study of E-cadherin and Ki-67 as prognostic markers. J Surg Oncol 2007;95:110-117. https://doi.org/10.1002/jso.20616
  15. Gilligan CJ, Lawton GP, Tang LH, West AB, Modlin IM. Gastric carcinoid tumors: the biology and therapy of an enigmatic and controversial lesion. Am J Gastroenterol 1995; 90:338-352.
  16. Choi MY, Sim YS, Kim IJ, et al. A case of concurrent gastric neuroendocrine carcinoma and adenocarcinoma: composite tumor combined with collision tumor. Korean J Med 2008;74 (suppl 1):42S-47S.