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Korean J Gastroenterol  <  Volume 74(6); 2019 <  Articles

Korean J Gastroenterol 2019; 74(6): 349-355  https://doi.org/10.4166/kjg.2019.74.6.349
Mixed Neuroendocrine-non-neuroendocrine Neoplasm of the Stomach that is Distributed in Depth on the Same Tumor: Inconsistent with the Definition of Mixed Adenoneuroendocrine Carcinoma in the 2010 World Health Organization Classification of Tumors of the Digestive System
Joonnho Jeong, Kyoungwon Jung , Jae Hyun Kim, Sung Eun Kim, Won Moon, Moo In Park and Seun Ja Park
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
Correspondence to: Kyoungwon Jung, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: +82-51-990-6103, Fax: +82-51-990-5055, E-mail: forjkw@gmail.com, ORCID: https://orcid.org/0000-0002-5324-7803
Received: April 15, 2019; Revised: September 4, 2019; Accepted: September 30, 2019; Published online: December 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
A mixed adenoneuroendocrine carcinoma (MANEC) of the stomach is a rare disease entity that was first defined by the World Health Organization (WHO) classification (2010) for tumors of the digestive system. According to the WHO classification (2010), MANEC is referred to as a tumor with both neuroendocrine and non-neuroendocrine neoplasms; each component of the tumor should be at least 30%. On the other hand, this cut-off value lacks clinical evidence and does not explain the characteristics and heterogeneity of this tumor. A 66-year-old male diagnosed with early gastric cancer (EGC) at a community hospital was referred to the Kosin University Gospel Hospital for further evaluation of gastric cancer. Esophagogastroduodenoscopy and EUS performed at the Kosin University Gospel Hospital revealed a sub-mucosal tumor-like component. In addition, a re-biopsy revealed a neuroendorine tumor at different depths of the same tumor. The final pathologic-diagnosis through surgery revealed a mixed neuroendocrine- non-neuroendocrine neoplasm, which is inconsistent with the definition of MANEC. Clinicians should consider EUS when a tumor has atypical endoscopic findings, even if EGC has already been diagnosed.
Keywords: Stomach neoplasms; Adenocarcinoma; Neuroendocrine tumors; World Health Organization


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