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122 NEUROENDOCRINE GASTROINTESTINAL TUMOR OF UNCLEAR ORIGIN: CASE REPORT AND REVIEW OF THE LITERATURE
  1. J. Barriga,
  2. K. Allen,
  3. P. Sylvestre,
  4. C. Tombazzi
  1. Department of Internal Medicine, University of Tennessee, 1Helsinki University Hospital

Abstract

Introduction Esophageal and gastric neuroendocrine tumors are exceptional. We present an unusual case of a patient with a gastric and esophageal neuroendocrine tumor.

Case Report A 68-year-old African American male presented to the Regional Medical Center in Memphis, TN, with an approximately 3-month history of decreased appetite, solid food dysphagia, and 30 pound weight loss. He also admit a 30 pack-year history of tobacco use and remote ETOH abuse. Chest/abdominal CT scan showed extensive and bulky mediastinal lymphadenopathy in pulmonary window, pretracheal space and precarinal region, an ill-defined mid to distal esophageal thickening suspicious for carcinoma; there was also a soft tissue mass in the gastroesophageal junction region compatible with gastric tumor. The upper endoscopic study showed a noncircumferential, fungating esophageal mass, at 30 cm from the incisors, causing partial obstruction of lumen. Beyond the tumor there were 9 cm of endoscopically normal-looking esophageal mucosa down to the gastroesophageal junction. On retroflexed view in the stomach, a large ulcerated mass at the cardia was noticed. Biopsies from both areas showed a neuroendocrine carcinoma admixed with an undifferentiated epithelioid population. Special stains: esophageal and gastric sample: mucicarmine (-); esophageal biopsy: synaptophysin (+) reactive in small and large cell populations, pan-keratin (+) patchy reactivity, CD45 (LCA) (-), CD31 (-). The patient is currently on treatment with etoposide/cisplatin.

Discussion Neuroendocrine tumors account for 0.5% of all malignancies, and 62-67% occur in the GI tract. This type of neoplastic proliferation can occur throughout the GI tract, but most of them are found in the appendix and ileum (80%). They can exceptionally arise from the colon or esophagus. In our case it was not well defined if the primary site was the stomach or esophagus. We have to consider neuroendocrine tumor in the differential diagnosis of tumor arising from the stomach and esophagus in the same patient.

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