Thread by @TristanRutland7

GOJ mass, older patient.

@ZHOUSEH @MattieFarzin @pembeoltulu @RunjanChetty @ariella8 @Dr_Brian_Cox @ALBoothMD @DrBMcGinn @DrGeeONE @MAHoureih @TheKarenPinto

#GIpath #PathTwitter #Surgpath

Further Hx for @Meghna0630

Male,
PMHx: skin cancer, DM type2, BPH

Presents with SBO. Nodule in stomach and small bowel (below).

CK20 (both sites)

CK7

TTF-1

TTF-1 from SB nodule

Ki67

Final bits of Hx

GOJ mass--> large, extends in oesophagus.
No lung masses on imaging.

I have made this a bit of Hx difficult to directly access, to simulate finding Hx IRL...

Diagnosis:

Gastric neuroendocrine (small cell) carcinoma with metastasis to small bowel.

1/ Neuroendocrine carcinomas of the stomach are rare and only account for 1% of all gastric carcinomas.

2/ They are horrible and aggressive cancers than have a prognosis.

pubmed.ncbi.nlm.nih.gov/29895024/

3/ TTF-1 can be expressed in gastric (and many other) small cell carcinomas and is not a reliable marker for lung mets.

pubmed.ncbi.nlm.nih.gov/26469324/

4/ Recent studies show these tumours show different mutations compared with conventional gastric adenocarcinomas, including CPLX2 aka Complexin 2 (?future biomarker).

pubmed.ncbi.nlm.nih.gov/28239029/

5/ Lastly, Merkel cell polyomavirus has been detected in this case report below (not this case) of small cell carcinoma, so primary gastric Merkel cell carcinoma anyone?

pubmed.ncbi.nlm.nih.gov/24709111/