Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7936-7943
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7936
Long-term survival of gastric mixed neuroendocrine-non-neuroendocrine neoplasm: Two case reports
Lun-Tao Woo, Yong-Feng Ding, Chen-Yu Mao, Jiong Qian, Xiu-Ming Zhang, Nong Xu
Lun-Tao Woo, Yong-Feng Ding, Chen-Yu Mao, Jiong Qian, Xiu-Ming Zhang, Nong Xu, Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Woo LT performed the bibliographic retrieval and wrote the paper; Ding YF contributed to the paper revision; Mao CY and Qian J provided the data and detailed information of the patients; Zhang XM performed the pathological examination and immunohistochemistry of the specimens; Xu N conceived the whole idea and contributed to the manuscript revision.
Informed consent statement: Written informed consents were obtained from the patients for publication of this case report.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nong Xu, MS, Chief Physician, Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. nongxu@zju.edu.cn
Received: November 18, 2021
Peer-review started: November 18, 2021
First decision: February 7, 2022
Revised: February 21, 2022
Accepted: June 26, 2022
Article in press: June 26, 2022
Published online: August 6, 2022
Processing time: 245 Days and 23.2 Hours
Abstract
BACKGROUND

Gastric mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), which consists of neuroendocrine and non-neuroendocrine components, is quite rare. Until now, most data on gastric MiNEN come from clinical cases, without large-scale retrospective studies or controlled clinical trials. Consequently, no consensus regarding the origin, molecular characteristics, or appropriate treatment of MiNEN has been reached so far. We conducted chemotherapy of irinotecan plus cisplatin (IP regimen) and surgery in two patients with gastric MiNEN, which had never been used in treating this kind of tumor, leading to their long-term survival for more than 3 and 7 years, respectively.

CASE SUMMARY

We present two patients (one male and one female) with gastric MiNEN, with the primary manifestation of recurrent upper abdominal pain. After they were referred to our hospital, a diagnosis of gastric MiNEN was defined with the help of CT scan, and histopathological and immunohistochemical examinations on the samples of gastrointestinal endoscopy or radical surgery. The male patient (case 1) were found to have metastases in the reginal lymph nodes and the left liver. He received four cycles of IP regimens first, then the gastrectomy and partial left liver resection, followed by additional two cycles of IP chemotherapy. The female patient (case 2) underwent a laparoscopic gastrectomy, and received six cycles of IP regimen. She was found to have metastatic lesions in the right lung 2 years after that, and underwent video-assisted thoracoscopic surgery (VATS) of the lower lobe of the right lung. The two patients have now survived for more than 3 years and 7 years, respectively, without any evidence of recurrence or metastases.

CONCLUSION

IP regimen, combined with curative-intent surgery if feasible, could be considered as the priority in the choice of front-line chemotherapy for gastric MiNEN.

Keywords: Gastric; Irinotecan plus cisplatin; Long-term survival; Mixed neuroendocrine-non-neuroendocrine neoplasm; Case report

Core Tip: Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is a rare, highly aggressive tumor with a poor prognosis (median overall survival less than 12 mo), and no consensus regarding the appropriate treatment has been reached so far. We conducted chemotherapy of irinotecan plus cisplatin regimen and surgery in two patients with gastric MiNEN, which had not been used to treat this kind of tumor before, leading to their long-term survival for more than 3 and 7 years, respectively. Our reports may provide a reference for other clinicians.