TRIPLE SYNCHRONOUS PRIMARY GASTRIC MALIGNANCIES drpocevski@gmail.com

 

TRIPLE SYNCHRONOUS PRIMARY GASTRIC MALIGNANCIES

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Stefan Bugarin stefanbugarin94@gmail.com First Surgical Clinic, Clinic for Digestive Surgery, UCCS, Belgrade IV Deparment Belgrade Serbia

Jovica Vasiljević jovica.vasiljevic@gmail.com First Surgical Clinic, Clinic for Digestive Surgery, UCCS, Belgrade IV Deparment Belgrade Serbia

Ognjen Aćimov drpocevski@gmail.com First Surgical Clinic, Clinic for Digestive Surgery, UCCS, Belgrade IV Deparment Belgrade Serbia

 

Serbia

Oral or Poster

Multiple synchronous primary gastric malignancies are extremely rare, especially when three different histological tumor types are involved. In literature, the most commonly reported combinations include synchronous adenocarcinoma and gastrointestinal stromal tumor (GIST), or adenocarcinoma with neuroendocrine tumors (NET). In our case we present triple synchronous primary gastric malignancy – the simultaneous occurrence of GIST, adenocarcinoma and NET as three independent primary tumors in the stomach – which has not been reported in the medical literature so far.

Female patient, 63 years old was admitted at VI Department of the First Surgical Clinic, Clinic for Digestive Surgery, Clinical Centre of Serbia with pain in left lower quadrant which she had in last four months. She noticed, two months ago, distension of abdomen and some mass in abdomen. Preoperatively it was done echosonography of abdomen, endoscopy and MDCt, beside standard blood analysis and tumor markers.

We present the case of a patient who has simultaneously three histologically different malignant tumors of the stomach: High-risk GIST (T4N0M0), Intramucosal adenocarcinoma (T1An0, 0/24 LN, Mx, L0V0PN0) and Low grade neuroendocrine tumor, NET-G1 (T1). The patient was successfully treated with radical surgical resection – total gastrectomy with D2 lymphadenectomy, omentectomy and Roux-en-Y reconstruction. Adjuvant postoperative therapy included Imatinib 300mg in three monts. After surgery, the patient was followed up for four years with no signs of recurrence.

The case provides a significant contribution to the understanding of the complexity of the pathogenesis of multiple synchronous malignancies.