Metachronous occurrence of gastric carcinoma after gastric stromal tumor : Considerations on therapeutic strategy

INTRODUCTION: To our knowledge, the metachronous occurrence of a stromal and epithelial gastric tumour has not been previously reported in the Literature. CASE REPORT: A 73-year-old man underwent open resection of a gastric stromal tumour located in the posterior antrum wall. The maximum size of the tumour was 5 cm, and final histological examination diagnosed it as a primary gastrointestinal autonomic nerve tumour (the so-called GAN tumour); mitotic index was intermediate (10 x 50 HPF). Twelve months later, during endoscopic follow-up, a small ulcerated adenocarcinoma was found at the gastric angulus and subtotal gastrectomy with D2 lymphadenectomy was performed. Final pathological stadiation was T1smN0. The patient is alive and disease free 50 months later. Since he has had two tumours, it would appear that this patient has a tendency to develop neoplasia. However, no risk factor was found being consistent with an aetiological role in both tumours, if we exclude the presence of chronic atrophic gastritis with intestinal metaplasia in the gastric mucosa around both tumours. CONCLUSIONS: In those cases of gastric stromal tumours, of intermediate size and mitotic index, in whom a wedge gastric resection may be proposed, a radical gastrectomy should be considered as a valid alternative, especially when, as in the described patient, chronic atrophic gastritis with intestinal metaplasia is associated.