PMC3961407_01
(A) Gastric fiberscopy of the tumor (neuroendocrine carcinoma and moderately differentiated adenocarcinoma) occupying the bottom of the stomach and its body curvature side. (B) Contrast-enhanced computed tomography scanning of the tumor (neuroendocrine carcinoma and moderately differentiated adenocarcinoma). (C) Neuroendocrine carcinoma with moderately differentiated adenocarcinoma and (D) mucinous adenocarcinoma were identified by microscopy (hematoxylin and eosin staining; magnification, x100). Postoperative immunohistochemistry results confirmed the diagnosis of neuroendocrine carcinoma, by the presence of (E) synaptophysin (+) and (F) chromogranin A (+).
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CT results identified that the staging of the tumor was T3N3M0 (Fig. 1). The tumor lied in the lesser curvature of the lower part of the stomach and the body of the stomach (Fig. 1A). Tumor 1 included two types of carcinoma (Fig. 1C), NEC and moderately differentiated adenocarcinoma, which can be referred to as mixed carcinoma or collision carcinoma, invading the subserosal connective tissue. Immunohistochemical results for NEC revealed: Chromogranin A (CgA; +) (Fig. 1E), synaptophysin (Syn; +) (Fig. 1F), vimentin (+), thyroid transcription factor-1 (+), CD117 (+) and Ki67 (+ 80%); while those for moderately differentiated adenocarcinoma were as follows: Ki67 (20%), epithelial membrane antigen (EMA; +), CK20 (+), CK7 (+) and villin (+).