Some special types of stomach tumors are often encountered in clinical paractice, such as gastrointestinal stromal tumor (GIST), gastric neuroendocrine tumors (NETs), primary gastric lymphoma (PGL) and some special types of gastric cancer. Because of their special pathogenesis and pathological types with lower incidence, the choices of the treatment for these diseases are limited. This article analyzes these special types of stomach tumors in order to improve the understanding of doctors in these diseases.
Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Lymphoma ; pathology ; surgery ; Neuroendocrine Tumors ; pathology ; surgery ; Stomach Neoplasms ; pathology ; surgery

Laparoscopic approaches are increasingly used in pancreatic surgery. In the treatment of neuroendocrine tumors (NETs) of the pancreas, enucleation is one of the recommended surgery. Although many clinical experiences have reported the safety and efficacy of laparoscopic enucleation of functioning NETs, such as insulinomas, few reports have explored such treatment for non-functioning NETs. Here, we present a case of 70-year old female patient who underwent successful laparoscopic enucleation of a nonfunctioning NET located in the body of the pancreas.
Aged ; Female ; Humans ; *Laparoscopy ; Neuroendocrine Tumors/pathology/*surgery/ultrasonography ; Pancreatic Neoplasms/pathology/*surgery/ultrasonography

Gastrointestinal Neoplasms ; Humans ; Intestinal Neoplasms/surgery* ; Neuroendocrine Tumors/pathology* ; Pancreatic Neoplasms/surgery* ; Stomach Neoplasms/pathology*

Neuroendocrine tumors of the extrahepatic biliary tree are extremely rare malignancies accounting for 0.2-2.0% of all gastrointestinal carcinoid tumors. Neuroendocrine tumors obstructing the biliary tree are extremely difficult to diagnose preoperatively and nearly impossible to differentiate from cholangiocarcinoma. Statistically, the most common anatomic location in the biliary tree is the common bile duct, followed by the perihilar region. Herein, we present a case of a small cell neuroendocrine carcinoma of the hilum in a 79-year-old man following laparotomy. To our knowledge, this is the first case of small cell type neuroendocrine carcinoma of hilar bile duct reported in Korea.
Aged ; Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis, Differential ; Hepatic Duct, Common/pathology ; Humans ; Male ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Objective: To investigate the clinical features, morphological characteristics, immunophenotype, and differential diagnosis of goblet cell adenocarcinoma (GCA) in the digestive system. Methods: The clinicopathological data, morphological characteristics, immunophenotypes of 22 cases of GCA in the digestive system diagnosed from January 2010 to January 2021 were collected. Meanwhile, 25 cases of neuroendocrine neoplasm (NEN) and 24 cases of adenocarcinoma were used as controls. Relevant literature was also reviewed. Results: There were 16 males and 6 females, aged from 36 to 79 years with an average of 56 years. The anatomical sites of the 22 GCA were mostly appendix (17 cases) and occasionally extra-appendix (5 cases), including 3 cases in stomach, 1 case in duodenum and 1 case in anal. All 17 cases of appendiceal GCA were pure GCA. Among the 5 cases of extra-appendiceal GCA, One case of gastric GCA was pure, two cases of gastric GCA with NEN or adenocarcinoma, duodenal GCA with NEN and adenocarcinoma, anal GCA with NEN.Low-grade GCAs were composed of goblet, Paneth and neuroendocrine cells, which were arranged in intestinal crypt tubular or cluster structures and distributed in the wall of digestive system. The tubular and cluster structures lacked adhesion. Goblet cells were columnar, located in the base, with clear cytoplasm, small nuclei, inconspicuous atypia, and uncommon mitoses. Extracellular mucus and signet-ring cells with nuclear variations could be seen in some cases. Nerve fiber bundle invasion and tumor thrombus in vessels were often present. High-grade GCAs lacked tubular and cluster structures, and their histological structures were more complex. Tumor cells expressed mixed neuroendocrine and glandular epithelial markers. Similar to the expression patterns of synaptophysin and chromogranin A, CD200 and INSM1 were also dot-like or patch-positive in GCA. Conclusions: GCA is an infrequent tumor of the digestive system and shows the bi-directional differentiation characteristics of neuroendocrine and glandular epithelium. Accurate diagnosis and staging are related to its prognosis.
Adenocarcinoma/pathology* ; Appendiceal Neoplasms/surgery* ; Carcinoid Tumor/surgery* ; Chromogranin A ; Female ; Goblet Cells/pathology* ; Humans ; Male ; Neuroendocrine Tumors/pathology* ; Repressor Proteins ; Synaptophysin

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
Adult ; Aged ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed

Neuroendocrine tumor (NET) is a cancer-like tumor that occurs mostly in the gastrointestinal system. Within the gastrointestinal tract, NET most commonly occurs in the rectum whereas appendix is very rarely involved. In most cases of appendiceal NET, it is found at a relatively early stage compared to other NETs because appendiceal NET frequently presents with acute appendicitis because appendiceal NET frequently presents with acute appendicitis even when the size is smaller than 1 cm. Therefore, it is very rare for lymph node metastasis to occur in a young adult. Herein, we report a rare case of grade 1 appendiceal NET with lymph node metastasis which developed in a teenage male.
Adolescent ; Appendiceal Neoplasms/*diagnosis/pathology/surgery ; Carcinoid Tumor/diagnosis/pathology ; Colectomy ; Colonoscopy ; Humans ; Lymphatic Metastasis ; Male ; Neuroendocrine Tumors/*diagnosis/pathology ; Tomography, X-Ray Computed

Gangliocytic paraganglioma (GP) is a rare, benign tumor which is usually found in the duodenum. We here report four recent cases of GP, with successful endoscopic resection in three cases, including a lesion on the ampulla of Vater. In all cases, each lesion had a stalk that facilitated removal using an endoscopic approach. Endoscopic mucosal resection is a feasible and safe treatment if the location, depth, and lymph node status are all favorable and is also helpful for definite diagnosis of unknown duodenal mass. To avoid morbidity resulting from open surgical resection, careful inspection for the peduncle of the GP will help determine the feasibility of endoscopic resection.
Aged ; Ampulla of Vater/pathology ; Chromogranin A/metabolism ; Colonoscopy ; Duodenal Neoplasms/pathology/*surgery ; Endoscopy, Gastrointestinal ; Female ; Humans ; Immunohistochemistry ; Intestinal Mucosa/pathology/surgery ; Male ; Middle Aged ; Neuroendocrine Tumors/pathology/surgery ; Paraganglioma/pathology/*surgery ; S100 Proteins/metabolism ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features and differential diagnosis of 18 cases of endocrine ductal carcinoma-in-situ (E-DCIS).

METHODSEighteen cases of breast cancer with features of E-DCIS were studied by light microscopy, histochemistry and immunohistochemistry. E-DCIS was diagnosed if the histologic patterns were compatible with those described in the literature and at least 50% of the tumor cells expressing two of the three neuroendocrine markers employed (chromogranin, synaptophysin and neuron-specific enolase).

RESULTSE-DCIS tended to occur in older women. All the patients were over 61 years old (mean age=71 years). The presenting symptoms were either palpable breast mass or had nipple discharge. Histologically, E-DCIS demonstrated an expansile intraductal growth pattern. Intraductal papilloma was not uncommon at the peripheral area of the tumor. The tumor cells were polygonal, oval or spindle in shape and contained abundant eosinophilic to granular cytoplasm and mildly to moderately pleomorphic nuclei. Intracellular or extracellular mucin was highlighted by periodic acid-Schiff (with diastase digestion) or alcian blue stains. Some tumor cells assumed a signet-ring configuration. All the three neuroendocrine markers were expressed by more than 50% of the E-DCIS cells. The neuroendocrine differentiation was further confirmed in some cases by CD57 and CD56 immunostaining. Pagetoid spread into adjacent ductolobular units was frequently seen in E-DCIS, and the expanded lobules were often not rimmed by myoepithelial cells. These two features helped to distinguish E-DCIS from usual ductal hyperplasia.

CONCLUSIONSE-DCIS represents a subgroup of low-grade DCIS, which carries characteristic morphologic features and immunophenotype. Conventional light microscopy usually permits a correct diagnosis. Ancillary histochemical and immunohistochemical studies can be helpful in doubtful cases.

Aged ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Carcinoma in Situ ; metabolism ; pathology ; surgery ; Carcinoma, Intraductal, Noninfiltrating ; metabolism ; pathology ; surgery ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Mastectomy ; methods ; Middle Aged ; Neuroendocrine Tumors ; metabolism ; pathology ; surgery ; Phosphopyruvate Hydratase ; metabolism ; Synaptophysin ; metabolism

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma
Aged ; Biopsy ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung Diseases ; Mediastinum ; Nausea ; Neurilemmoma* ; Neuroendocrine Tumors ; Osmolar Concentration ; Pathology ; Plasma ; Sodium ; Thoracic Surgery, Video-Assisted ; Thorax ; Vomiting