Acta Medica 2013; 2: 45–47
acta medica
CASE R EPORT
The Benefit Of Chemotherapy In
A Patient With Gastric Medullary Cancer
Mehmet Metin SEKER1*, [MD]
Ozan YAZICI2, [MD]
Nesrin TURHAN3, [MD]
Sercan AKSOY4, [MD]
Turgut KACAN1, [MD]
Nalan A. BABACAN1, [MD]
Nuriye Y. OZDEMIR2, [MD]
Dogan UNCU2, [MD]
Nurullah ZENGIN2, [MD]
1 Department of Medical Oncology, Cumhuriyet
University, Faculty of Medicine, Sivas, Turkey
2 Department of Medical Oncology, Numune
Research and Education Hospital, Ankara, Turkey
3 Department of Pathology, Numune Research
and Education Hospital, Ankara, Turkey
4 Department of Medical Oncology, Hacettepe
University, Faculty of Medicine, Ankara, Turkey
A BST R AC T
Undifferentiated gastric carcinomas with few glandular structures and scanty
stroma are called “medullary type gastric carcinoma (MGC) ”. MGC is very
rare in Turkey and in Western countries. So there is limited data about the
choice of chemotherapy for MGC. Here, we present a sixty-eight years old female MGC patient treated with surgery and adjuvant fluorouracil and leucovorin chemotherapy. Subtotal gastrectomy was performed. Dense lymphocytes
and plasma cells containing scanty stroma and neoplastic cell clusters with tubuler differentiation were detected at the pathological examination. Six course
of fluorouracil and folinic acid had been applied as adjuvant chemotherapy. She
had no relapse until the 30 months of follow up. MGC is commonly seen in the
sixth decade and had a male predominance. The disease tends to be located in
distal parts of the stomach. Mean tumor size for MGC is bigger than well-differentiated gastric adeno carcinoma but smaller than scirrhous type gastric adeno carcinoma. Based on the successful experience in the present case, here we
suggest the use of fluoropyrimidine based therapies in the early stage of MGC.
Key words: Chemotherapy, gastric medullary cancer, prognosis
* Corresponding Author: Mehmet Metin Seker
Cumhuriyet University, Faculty of Medicine,
Department of Medical Oncology,
Sivas-TURKEY
Phone +90 (346) 258 14 00
[email protected]
Received 9 July 2013; accepted 24 July 2013
Introduction
Gastric carcinomas (GC) are divided in two major
histopathologic types: an intestinal or differentiated type and diffuse or undifferentiated type. Most of
the undifferentiated GC have abundant fibrous stroma, so called “scirrhous type carcinoma”. The undifferentiated GC with few glandular structures and
scanty stroma are called “medullary type GC (MGC)
” [1]. These two histological subtypes have some clinical and pathological differences. MGC has less deep
invasion, less originated from the proximal part of
stomach, has less lymph node and peritoneal metastasis but has more liver metastasis, more lympho-vascular invasion and better prognosis [2].
Although, the incidence of MGC is 2-4% among
the all gastric cancer cases in far East, it is very rare
© 2013 Acta Medica. All rights reserved.
in Turkey and in Western countries [3]. Therefore
there is no consensus about GMC treatment. Here,
we present an early stage MGC patient treated with
surgery and adjuvant chemotherapy.
Case Report
Sixty-eight years old female patient was admitted to the hospital with gastric pain. She did not
have a comorbid disease. Upper gastrointestinal
system endoscopy was performed and a tumoral
mass was observed at the gastric antrum. After the
pathologic examination of the biopsy, the diagnosis was less differentiated adenocarcinoma. Then
the patient had a subtotal distal gastectomy and D2
lymph node dissection. The tumor size was 10x7x2
cm and it had subserosal infiltration. A total of 33
45
Gastric Medullary Cancer
Figure 1A. Gastric medullary carcinoma with lymphoid stroma has a well-defined advancing growth margin (hematoxylin eosin). 1B: Abundant T cell lymphocytic infiltration are stained with CD3.
lymph nodes had been examined and none of them
was metastatic. At the pathological examination
the tumor consisted of mostly solid nests of large
eosinophilic carcinoma cells with relatively inconspicuous tubular differentiation, that were admixed with a dense and diffuse infiltrate of mature
lymphocytes and plasma cells. The tumor margins
were well defined and growth pattern was expansive (Figure 1A–1B).
Thorax and abdomen computerized tomography
was performed and no metastasis was noticed. The
stage was T3N0M0 according to the TNM 7th edition. Six course of fluorourasil and folinic acid had
been applied as adjuvant chemotherapy. She had no
relapse until the 30 months of follow up.
Discussion
was not a statistically significant survival difference
between MGC and non-medullary type. In the study
of Adachi et al., 51% of the patients had disease at
corpus or antrum and mean tumor size was 8.5 cm
in MGC and 8.9 cm in non-medullary type [1]. In
our patient the disease was at antrum and the tumor
size was 10 cm. Additionally, there was no lymph
node metastasis in any of the 33 dissected nodes.
Although it has been reported that the prognosis
of MGC is better than SGC and like as WGC, there
is limited data about the choice of chemotherapy
regimen [4]. In the study of Otsuji et al., the 5-year
survival rate for MGC patients was 21%. We treated our patient with surgery followed by 6 courses of
fluorouracil and folinic acid. Until now, she has had
no relapse for 30 months. Therefore we think that
fluoropyrimidine based therapies may be appropriate for MGC.
MGC is a very rare gastric neoplasm. Although it
has been commonly seen in the sixth decade and
had a male predominance, the present case was a Conclusion
seventh decade female patient. The disease tends to MGC is a very rare gastric neoplasm especially in
be localized in the distal part of stomach. Mean tu- Turkey and Western countries. There are few data
mor size of MGC is bigger than that of well-differ- about clinical and pathological features of MGC,
entiated gastric adeno carcinoma (WGC) but small- and very limited information about ideal chemoer than that of scirrhous type gastric adeno carcino- therapy regimen for MGC. Although the disease
ma (SGC). In the study of Otsuji et al., the disease was early stage and the tumor was well differentiwas at corpus or antrum in 93% of the patients and ated in our patient, we suggest that fluoropyrimithe mean tumor size was 5.6 cm, 8.8 cm and 4.4 cm dine based therapies may be a treatment of choice
in MGC, SGC and WGC, respectively [2]. Although for these patients. Further clinical trials are needed
none of the patients received chemotherapy, there for more definite conclusions.
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© 2013 Acta Medica. All rights reserved.
Acta Medica 2013; 2: 45–47
Seker et al.
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© 2013 Acta Medica. All rights reserved.
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