Multifokales Siegelringzell-Adenokarzinom des Magens mit inzidentellem gastrointestinalem Stromatumor in einer Typ-B-Gastritis

Zusammenfassung

Ein 79-jähriger Patient wurde zur Abklärung einer mikrozytären hypochromen Anämie unter einer Marcumar-Therapie eingewiesen. Bei Verdacht auf eine gastrointestinale Blutung wurde eine Ösophagogastroduodenoskopie (ÖGD) durchgeführt, die ein großes multifokales, schlecht differenziertes Siegelringzell-Adenokarzinom des Magens (diffuser Typ nach Lauren) zeigte. Nach üblichen Staginguntersuchungen wurde eine D 2-Gastrektomie durchgeführt. Nach histologischer Aufarbeitung zeigten sich ein multifokales schlecht differenziertes Adenokarzinom mit einer Infiltration bis in die Submukosa (sog. Frühkarzinom vom Submukosatyp) und zufällig ein bis dahin nicht bekannter, 0,8 cm im Durchmesser großer gastrointestinaler Stromatumor (GIST). Nach Literaturdurchsicht dokumentierten wir hier erstmalig ein multifokales Siegelringzell-Adenokarzinom des Magens mit zusätzlichem GIST in einer Typ-B-Gastritis.

Abstract

A 79-year-old man was admitted because of anemia during marcumar therapy with suspected bleeding in the gastrointestinal tract. Endoscopy revealed a large mutifocal poorly differentiated gastric signet ring cell adenocarcinoma. After staging by the usual oesophagogastroduodenoscopic method, a total D 2 gastrectomy was performed. In the pathological resection specimen of the stomach, a multifocal poorly differentiated signet ring cell adenocarcinoma, infiltrating the submucosa (so called early cancer of sm-type) and an incidental gastroinstinal stromal tumour, 0.8 cm in diameter, was diagnosed. This is the first case report of the synchronous occurrence of a multifocal poorly differentiated gastric adenocarcinoma with signet-ring cell morphology (diffuse type according to the Lauren classification) and a GIST incidentally within a stomach with Hp-associated gastritis.

Schlüsselwörter

chronische gastrointestinale Blutung - gastrointestinaler Stromatumor (GIST) - Helicobacter pylori - Magenkarzinom

Key words

chronic gastrointestinal bleeding - gastrointestinal stromal tumour (GIST) - Helicobacter pylori - stomach cancer

Literatur

• 1 Agaimy A, Wünsch P H, Sobin L H et al. Occurrence of other malignancies in patients with gastrointestinal stromal tumors.  Semin Diagn Pathol. 2006;  23 120-129
• 2 Cohen A, Geller S A, Horowitz I et al. Experimental models for gastric leiomyosarcoma. The effects of N-methyl-N’-nitro-N-nitrosoguanidine in combination with stress, aspirin, or sodium taurocholate.  Cancer. 1984;  53 1088-1092
• 3 Corless C L, Fletcher J A, Heinrich M C. Biology of gastrointestinal stromal tumors.  J Clin Oncol. 2004;  22 3813-3825
• 4 Fletcher C D, Berman J J, Corless C et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach.  Hum Pathol. 2002;  33 459-465
• 5 Woodall 3 rd C E, Brock G N, Fan J et al. An evaluation of 2537 gastrointestinal stromal tumors for a proposed clinical staging system.  Arch Surg. 2009;  144 (7) 670-678
• 6 Guilford P, Humar B, Blair V. Hereditary diffuse gastric cancer: translation of CDH1 germline mutations into clinical practice.  Gastric Cancer. 2010;  13 (1) 1-10 Epub 2010 Apr 7
• 7 Huntsman D G, Carneiro F, Lewis F R et al. Early gastric cancer in young, asymptomatic carriers of germ-line E-cadherin mutations.  N Engl J Med. 2001;  344 (25) 1904-1909
• 8 Lee J J, Yang T L, Huang S H et al. Malignant transformation of multiple gastric adenomatous polyps in a teenage girl: a case report.  Zhonghua Yi Xue Za Zhi. 1993;  52 (4) 280-283
• 9 Conley M E, Ziegler M M, Borden 4th S et al. Multifocal adenocarcinoma of the stomach in a child with common variable immunodeficiency.  J Pediatr Gastroenterol Nutr. 1988;  7 (3) 456-460
• 10 Koike K, Hinrichs S H, Isselbacher K J et al. Transgenic mouse model for human gastric carcinoma.  Proc Natl Acad Sci U S A. 1989;  86 (14) 5615-5619
• 11 Humar B, Blair V, Charlton A et al. E-cadherin deficiency initiates gastric signet-ring cell carcinoma in mice and man.  Cancer Res. 2009;  69 (5) 2050-2056 Epub 2009 Feb 17
• 12 Liu Y J, Yang Z, Hao L S et al. Synchronous incidental gastrointestinal stromal and epithelial malignant tumors.  World J Gastroenterol. 2009;  15 (16) 2027-2031
• 13 Wronski M, Ziarkiewicz-Wroblewska B, Gornicka B et al. Synchronous occurrence of gastrointestinal stromal tumors and other primary gastrointestinal neoplasms.  World J Gastroenterol. 2006;  12 (33) 5360-5362
• 14 Miettinen M, Lasota J. Gastrointestinal stromal tumors – definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis.  Virchows Arch. 2001;  438 (1) 1-12
• 15 Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis.  Arch Pathol Lab Med. 2006;  130 (10) 1466-1478
• 16 Ng E H, Pollock R E, Munsell M F et al. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging.  Ann Surg. 1992;  215 (1) 68-77
• 17 Nilsson B, Bümming P, Meis-Kindblom J M et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era – a population-based study in western Sweden.  Cancer. 2005;  103 (4) 821-829
• 18 Kawanowa K, Sakuma Y, Sakurai S et al. High incidence of microscopic gastrointestinal stromal tumors in the stomach.  Hum Pathol. 2006;  37 (12) 1527-1535 Epub 2006 Sep 25
• 19 Uemura N, Okamoto S, Yamamoto S et al. Helicobacter pylori infection and the development of gastric cancer.  N Engl J Med. 2001;  345 (11) 784-789
• 20 Bi R, Sheng W, Wang J. Collision tumor of the stomach: gastric adenocarcinoma intermixed with gastrointestinal stromal tumor.  Pathol Int. 2009;  59 (12) 880-883
• 21 Ozgun Y M, Ergul E, Sisman I C et al. Gastric adenocarcinoma and GIST (collision tumors) of the stomach presenting with perforation, first report.  Bratisl Lek Listy. 2009;  110 (8) 504-505
• 22 Kountourakis P, Arnogiannaki N, Stavrinides I et al. Concomitant gastric adenocarcinoma and stromal tumor in a woman with polymyalgia rheumatica.  World J Gastroenterol. 2008;  14 (43) 6750-6752
• 23 Salemis N S, Gourgiotis S, Tsiambas E et al. Synchronous occurrence of advanced adenocarcinoma with a stromal tumor in the stomach: a case report.  J Gastrointestin Liver Dis. 2008;  17 (2) 213-215
• 24 Villias C, Gourgiotis S, Veloudis G et al. Synchronous early gastric cancer and gastrointestinal stromal tumor in the stomach of a patient with idiopathic thrombocytopenic purpura.  J Dig Dis. 2008;  9 (2) 104-107
• 25 Uchiyama S, Nagano M, Takahashi N et al. Synchronous adenocarcinoma and gastrointestinal stromal tumors of the stomach treated laparoscopically.  Int J Clin Oncol. 2007;  12 (6) 478-481 Epub 2007 Dec 21
• 26 Lee F Y, Jan Y J, Wang J et al. Synchronous gastric gastrointestinal stromal tumor and signet-ring cell adenocarcinoma: a case report.  Int J Surg Pathol. 2007;  15 (4) 397-400
• 27 Chen J H, Chen C C, Tzeng L M et al. Resection of triple synchronous tumors – gastric adenocarcinoma, gallbladder adenocarcinoma and stromal tumor of the stomach.  Zhonghua Yi Xue Za Zhi. 2001;  64 (11) 655-660
• 28 Rauf F, Ahmad Z, Muzzafar S et al. Synchronous occurrence of gastrointestinal stromal tumor and gastric adenocarcinoma: a case report.  J Pak Med Assoc. 2006;  56 (4) 184-186
• 29 Lin Y L, Tzeng J E, Wei C K et al. Small gastrointestinal stromal tumor concomitant with early gastric cancer: a case report.  World J Gastroenterol. 2006;  12 (5) 815-817
• 30 Bircan S, Candir O, Aydin S et al. Synchronous primary adenocarcinoma and gastrointestinal stromal tumor in the stomach: a report of two cases.  Turk J Gastroenterol. 2004;  15 (3) 187-191
• 31 Kaffes A, Hughes L, Hollinshead J et al. Synchronous primary adenocarcinoma, mucosa-associated lymphoid tissue lymphoma and a stromal tumor in a Helicobacter pylori-infected stomach.  J Gastroenterol Hepatol. 2002;  17 (9) 1033-1036
• 32 Katsoulis I E, Bossi M, Richman P I et al. Collision of adenocarcinoma and gastrointestinal stromal tumour (GIST) in the stomach: report of a case.  Int Semin Surg Oncol. 2007;  4 2
• 33 Liu S W, Chen G H, Hsieh P P. Collision tumor of the stomach: a case report of mixed gastrointestinal stromal tumor and adenocarcinoma.  J Clin Gastroenterol. 2002;  35 (4) 332-334