We report a case of primary gastric small cell carcinoma presented a specific morphology.
A 74-year-old man, who had intermittent abdominal pain starting in about November 2003 and was found having an upper abdominal tumor at another hospital on January 8 2004, was referred to the hospital for further examinations. Gastrointestinal endoscopy, upper gastrointestinal series and computed tomography (CT) showed a huge pedunculated tumor in the greater curvature of the body of the stomach. Distal gastrectomy with D2 lymphadenectomy and cholesystectomy were performed under a diagnosis of advanced gastric adenocarcinoma with a peduncle. Pathologic examination of the resected specimen showed coexistence of adenocarcinoma and small cell carcinoma with a high N/C ratio. Immunohistochemically, these small cells were stained positive for synaptophysin. The final pathological diagnosis was small cell carcinoma of the stomach with severe lymphatic invasion. We orally administered S-1 as adjuvant chemotherapy for 4 courses, starting on postoperative day 19. Seven months after the operation lymph node metastasis in the vicinity of the pancreas head was detected by abdominal CT scan, but the metastasis was well controlled by sustained chemotherapy with S-1 and paclitaxel. There has been no increasing tendency in size of the metastatic lesion and the patient has been on chemotherapy on an ambulant basis, as of one year after the operation. The patient's good QOL has been kept.
Since this case of small cell carcinoma of the stomach is rare in that a huge mass was formed and the patient has been alive without declining QOL one year after the operation, we report it here, together with a review of the literature. On postoperative 1 year, abdominal CT showed the lymph node metastasis by pancreas was exactly the same as before. Patients with small cell carcinoma of the stomach are reported to have very poor prognosis, however, this patient lives 1 year after the first operation without reduction in the quality of life.