Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8090-8096
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8090
Mixed neuroendocrine carcinoma of the gastric stump: A case report
Hui Zhu, Ming-Yuan Zhang, Wei-Liang Sun, Gun Chen
Hui Zhu, Ming-Yuan Zhang, Wei-Liang Sun, Gastrointestinal Surgery Department, The Affiliated People's Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
Gun Chen, Pathologic Department, The Affiliated People's Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
Author contributions: Zhu H and Sun WL performed the surgery, reviewed the literature, and contributed to manuscript drafting; Chen G performed the pathological work; Zhang MY designed the study and was responsible for manuscript drafting and analysis.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Yuan Zhang, MD, Chief Doctor, Gastrointestinal Surgery Department, The Affiliated People's Hospital of Ningbo University, No. 251 East Baizhang Road, Yinzhou District, Ningbo 315000, Zhejiang Province, China. michael2052@163.com
Received: March 31, 2021
Peer-review started: March 31, 2021
First decision: April 28, 2021
Revised: May 6, 2021
Accepted: August 19, 2021
Article in press: August 19, 2021
Published online: September 26, 2021
Abstract
BACKGROUND

Gastric stump cancer, also known as gastric remnant cancer (GRC), is one of the main complications of postgastrectomy syndrome, which usually occurs following Billroth II reconstruction. The predominant histological subtype of GRC is adenocarcinoma, whereas neuroendocrine carcinoma is relatively rare. In particular, there are few recently reported cases of mixed neuroendocrine carcinoma (MNEC) in the English literature. Here, we present an extremely rare case of MNEC of the gastric stump.

CASE SUMMARY

A 59-year-old patient presented to our department owing to chronic constipation. He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer. After admission, the patient underwent several tests, and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site, with bile reflux; pathological biopsy revealed adenocarcinoma. He was then diagnosed with GRC and underwent total gastrectomy, D2 Lymphadenectomy, and esophagojejunal Roux-en-Y reconstruction. Histopathological examination of the specimen identified MNEC comprising MNEC (60%), adenocarcinoma (30%), and squamous cell carcinoma (10%). Postoperative adjuvant chemotherapy was initiated on September 17, 2020. Taxol plus cisplatin was administered for only one cycle because of severe liver function damage, and the regimen was changed to etoposide plus cisplatin on October 10, 2020 for five cycles. The patient recovered, with no recurrence after 6 mo of follow-up.

CONCLUSION

Gastric MNECs (GMNECs) is a rare type of GRC. This study presented the unusual occurrence of GMNEC in the gastric stump. This case will contribute to improvements in our understanding of the carcinogenesis, biology, pathology, and behavior of GMNEC and GRC.

Keywords: Gastric remnant cancer, Gastric mixed neuroendocrine carcinoma, Surgery, Gastric stump, Billroth II, Case report

Core Tip: The predominant type of gastric remnant cancer is adenocarcinoma, whereas neuroendocrine carcinoma is particularly rare. Currently, there are few previous reports of gastric mixed neuroendocrine carcinomas (GMNECs). The information provided in this report will improve our understanding of the carcinogenesis, biology, and behavior of GMNEC and gastric remnant cancer.