© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic diagnosis of a gastric small cell carcinoma with liver metastasis
17 November 2010 (online)
Primary small cell carcinomas of the stomach are extremely rare, accounting for less than 0.1 % of primary gastric cancers . The clinical behavior of primary gastric small cell carcinoma is as aggressive as that of small lung cancer . Distal metastases are frequently observed at initial presentation . Small cell carcinomas proliferates mainly in the submucosal layer like a carcinoid tumor  ; however, the tumor may have endoscopic features identical to those of gastric adenocarcinoma . Preoperative diagnosis of gastric small cell carcinoma is difficult because of its histological heterogeneity and microscopic resemblance to malignant lymphoma or undifferentiated adenocarcinoma  . We report here a case of primary small cell carcinoma of stomach with liver metastasis, which was correctly diagnosed with endoscopic and liver biopsy.
A 71-year-old man was referred to our institution for evaluation of multiple hepatic tumors. His past medical history was unremarkable. Physical examination revealed jaundice and a slightly distended abdomen. Laboratory data included a hematocrit of 40.9 % (normal 42 % – 52 %) and a total bilirubin level of 3.2 mg/dl (normal 0.2 – 1.2 mg/dl); the alpha-fetoprotein level was within normal limits. Chest radiography was unremarkable. Contrast-enhanced computed tomography showed multiple hepatic tumors over both lobes and an enhancing mass at the mid gastric body ([Fig. 1]).
Fig. 1 Contrast-enhanced computed tomography, showing multiple hepatic tumors over both lobes and an enhancing mass at the mid gastric body (arrow).
Upper endoscopy revealed a mucosal bulge with central ulceration at the mid gastric body ([Fig. 2]).
Fig. 2 Endoscopic view showing a mucosal bulge with central ulceration at the mid gastric body.
The histopathological assessment of the biopsy specimens demonstrated nests of small cells with hyperchromatism and scanty cytoplasm ([Fig. 3 a]).
Fig. 3 a Photomicrograph showing nests of small cells in the gastric mucosa with hyperchromatism and scanty cytoplasm (hematoxylin and eosin, magnification × 40). b Immunohistochemical staining positive for chromogranin. c Immunohistochemical staining positive for CK7.
Immunohistochemical staining revealed positivity for chromogranin ([Fig. 3 b]) and CK7 ([Fig. 3 c]). Immunostains for CEA, CK20, S100, TTF-1, and P53 were negative. Similar histopathological findings were obtained from the biopsy specimens taken from the liver tumors. A diagnosis of gastric small cell carcinoma with liver metastasis was made. The patient refused chemotherapy and died of hepatic failure 3 months later.
Competing interests: None
The page number has been corrected to E283 – E284.
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T. H. Yang, MD
Division of Gastroenterology
Department of Internal Medicine
Chang Bing Show-Chwan Memorial Hospital
No 6 Lugong Road
Changhua County 505