Synchronous occurrence of gastric cancer and gastrointestinal stromal tumor: A case report and review of the literature

doi:10.4251/wjgo.v15.i10.1807

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World J Gastrointest Oncol. Oct 15, 2023; 15(10): 1807-1822
Published online Oct 15, 2023. doi: 10.4251/wjgo.v15.i10.1807

Table 1 Clinicopathological features, treatment and outcome of gastric cancer in 19 patients

No.	Age in yr	Sex	BMI	Chief complaint	Disease duration (mo)	Comorbidities in yr	Tumor marker	Primary site	Size (cm)	pTNM	Gross appearance	Differentiation	Lauren type	Outcome
1	66	M	17.9	Epigastric discomfort	12.0	HBP/20	(-)	Pylorus	1.5	T3N0M0/IIA	Ulcerativeinfiltrative	M-P	Mixed	38 m, PFS
2	56	M	24.2	CT found by accident	2.0	No	(-)	Cardia, body, antrum	10.0	T3N1M0/IIB	Diffuse infiltrative	P, SRCC	Diffuse	NA
3	53	M	19.5	Upper abdominal pain	0.5	No	CA72-4↑	Body	4.5	T3N0M0/IIA	Ulcerative infiltrative	P, SRCC	NA	48 m, PFS
4	71	M	21.5	Epigastric discomfort	6.0	No	(-)	Body	2.0	T2N0M0/IB	NA	M-P	Mixed	53 m, PFS
5	45	M	21.8	Bloating, acid reflux	6.0	No	(-)	Pylorus	3.5	T3N2M0/IIIA	Ulcerative	M-P, SRCC	Diffuse	48 m, DOD
6	55	M	25.5	Epigastric discomfort	2.0	No	(-)	Antrum	4.0	T1bN0M0/IA	Ulcerative	M-P, SRCC	Intestinal	6 m, PFS
7	79	F	22.2	Heartburn, abdominal pain, black stools	2.0	HBP/10, DM/10	(-)	Antrum	3.0	TisN0M0/0	NA	HGIEN	NA	27 m, PFS
8	58	M	27.9	Upper abdominal pain	4.0	No	(-)	Antrum	5.0	T4aN0M0/IIB	Ulcerative	P	Diffuse	26 m, PFS
9	71	M	23.8	Epigastric pain, acid reflux	1.0	HBP/10	(-)	Antrum	3.5	T1bN0M0/IA	NA	M	Intestinal	23 m, PFS
10	56	M	23.2	Upper abdominal pain, choking eating, black stools	1.0	No	(-)	Cardia	1.5	T2N0M0/IB	Ulcerative infiltrative	M	Intestinal	NA
11	55	M	23.7	Abdominal distension	9.0	No	CEA↑	Fundus	3.0	T4aN3bM0/IIIC	Ulcerative	M	Intestinal	10 m, DOD
12	59	M	23.1	Abdominal distension, black stools	1.0	DM/6	(-)	Body	5.0	T2N0M0/IB	Ulcerative	P	Diffuse	20 m, PFS
13	62	M	22.9	Upper abdominal pain	12.0	No	CEA↑, CA724↑	Body	2.0	T3N0M0/IIA	Ulcerative	P, SRCC	Diffuse	9 m, PFS
14	49	M	13.1	Epigastric discomfort	12.0	No	(-)	Cardia, fundus	5.0	T4bN0M0/IIIA	Ulcerative	M-P	Mixed	45 m, PFS
15	65	F	23.6	Epigastric discomfort, abdominal distension	12.0	No	(-)	Cardia, body	2.5	T4aN1M0/IIIA	Ulcerative	M	NA	5 m, DOD
16	73	M	21.3	Epigastric discomfort	48.0	No	CA724↑	Body	5.0	T4aN3bM0/IIIC	Ulcerative	M-P	Diffuse	12 m, DOD
17	62	M	22.8	Upper abdominal pain	6.0	DM/6	CEA↑, CA125↑	Antrum	3.5	T4aN0M0/IIB	Ulcerative infiltrative	M	Intestinal	70 m, PFS
18	62	M	21.2	Progressive dysphagia	3.0	HBP/30	CA199↑	Cardia	4.5	T4aN2M0/IIIA	Ulcerative	M-P	Mixed	12 m, DOD
19	72	M	22.4	Upper abdominal pain	0.5	No	(-)	Body	1.5	T1bN0M0/IA	NA	W	NA	63 m, PFS

M: Male; F: Female; HBP: High blood pressure; DM: Diabetes Mellitus (Type 2); TG: Total gastrectomy; DG: Distal gastrectomy; PG: Proximal gastrectomy; pTNM: Pathological tumor-node-metastasis; SRCC: Signet-ring cell carcinoma; HGIEN: High-grade intraepithelial neoplasia; NA: Not assessed; PFS: Progression-free survival; DOD: Dead of disease; M-P: Moderately to poorly differentiated; M: Moderately differentiated; P: Poorly differentiated; W: Well differentiated.

Table 2 The clinical, histological and immunohistochemical characteristics of gastrointestinal stromal tumor in 19 patients

No.	CT	EGD	Location	Origin	Size (cm)	Type	Growth pattern	Mitotic index (HPF)	Risk category	CD117	CD34	Dog-1	S-100	SMA	VIM	IM
1	GIST	GIST	Antrum	Submucosal	9.0	Spindle, epithelioid	Intraluminal	< 5/50	High	+	+	+	-	-	NA	Yes
2	(-)	(-)	Body	Muscularis	0.4	NA	Intramural	< 5/50	Very low	++	+++	+++	-	-	NA	No
3	(-)	(-)	Body	Subserous	1.0	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
4	Mass	(-)	Duodenum	NA	2.0	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
5	(-)	(-)	Jejunum	NA	1.5	Spindle	Extraluminal	< 5/50	Low	++	+	+++	-		NA	No
6	(-)	GIST	Fundus	Muscularis	1.5	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
7	GIST	GIST	Body	NA	5.0	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
8	Mass	Mass	Fundus	Subserous	1.0	Spindle	Intraluminal	< 5/50	Low	+	+	+	-	NA	NA	No
9	(-)	Mass	Duodenum	NA	4.0	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
10	(-)	(-)	Cardia	Subserous	0.2	Spindle	Extraluminal	< 5/50	Very low	+	+	+	-	-	NA	No
11	GIST	GIST	Body	Muscularis	12.0	Spindle	Extraluminal, intraluminal	6-10/50	High	+	+	+	-	-	+	Yes
12	(-)	(-)	Jejunum	NA	4.0	Spindle	Extraluminal	< 5/50	Low	+	-	+	-	-	+	No
13	(-)	(-)	Body	Muscularis	0.4	Spindle	Intramural	< 5/50	Very low	+	+	+	-	-	NA	No
14	(-)	(-)	Fundus	Subserous	0.4	Spindle	Extraluminal	< 5/50	Very low	++	+++	+++	-	NA	NA	No
15	(-)	(-)	Body	Submucosal	0.6	Spindle	Intramural	< 5/50	Very low	+	+	+	-	-	NA	No
16	(-)	(-)	Body	Subserous	3.0.	Spindle	Extraluminal	< 5/50	Low	+	+	+	-	-	+	No
17	(-)	(-)	Antrum	Muscularis	< 1.0	NA	Intramural	< 5/50	Very low	+	+	NA	NA	NA	NA	No
18	(-)	(-)	Cardia, fundus	Subserous	0.4	Spindle	Extraluminal	< 5/50	Low	+	+	+	NA	-	NA	No
19	(-)	(-)	Body	Subserous	1.3	Spindle	Extraluminal	< 5/50	Very low	+	+	-	-	NA	+	No

NA: Not assessed; CT: Computed tomography; EGD: Esophagogastroduodenoscopy; V-L: Very low; L: Low; IN: Intermediate; H: High; IM: Imatinib mesylate; GC: Gastric cancer; GIST: Gastrointestinal stromal tumor.

Table 3 Details of the clinical, histological, immunohistochemical, and outcomes of concurrent gastric cancer and gastrointestinal stromal tumor summarized in this study and literature review

Ref.	Sex	Age in yr	GC					GIST					Outcome
Ref.	Sex	Age in yr	Location	Size (cm)	TNM status	Lauren	Differentiation	Location	Size (cm)	Risk	CD117	CD34	Outcome
Maiorana et al[6], 2000	F	81	Cardias	4.0	T2bN0M0, IB	Intestinal	NA	Fundus	5.0	L	NA		21 m, DOD
	F	79	Antrum	2.0	T1bN0M0, IA	Diffuse		Pylorus	6.0	H		+	54 m, PFS
	M	75	Antrum	4.0	T2bN1M0, IIA	Intestinal		Antrum	5.0	L			12 m, PFS
	F	79	Pylorus	1.2	T2aN1M0, IIA	Intestinal		Cardias	5.0	L		+	28 m, PFS
	M	79	Antrum	2.0	T2aN0M0, IB	Intestinal		Cardias	0.6	V-L		+	75 m, PFS
Bircan et al[7], 2004	71	Antrum	5.7	T3NxM0	Intestinal	P	Cardias	0.5	V-L	+	+	NA	71
Bircan et al[7], 2004	77	Cardias	7.5	T2N1M0, IIA	NA	M	Cardias	0.6	V-L	+	+	NA	77
Villias et al[8], 2008	M	78	Antrum	NA	T1N0M0, IA	Intestinal	M	Antrum	0.9	V-L	+	+	NA
Lin et al[9], 2006	F	70	Cardias	1.7	T1N0M0, IA	NA	P, SRCC	Fundus	1.1	V-L	+	+	14 m, PFS
Liu et al[10], 2018	M	72	Antrum	4.0	T2N1M0, IIA	NA	M	Fundus	2.0	V-L	+	+	18 m, PFS
Wronski et al[11], 2006	F	64	Antrum	5.0	T4N0M0, IIB	Diffuse	NA	Cardias	2.0	L	+	+	NA
Wronski et al[11], 2006	M	66	Cardias	1.0	T1N0M0, IA	Intestinal	NA	Cardias	1.0	V-L	+	+	NA
Theodosopoulos et al[63], 2011	M	80	Antrum	6.5	T1N0M0, IA	Intestinal	W	Body	3.0	IN	+	NA	12 m, PFS
Rauf et al[46], 2006	F	70	Antrum, body	10.0.	T4N1M0, IIIA	Diffuse	P, SRCC	Body	2.0	L	+	+	18 m, DOD
Namikawa et al[14], 2021	M	74	Body	2.0	T2N0M0, IB	NA	M	Body	2.2	L	NA	NA	1 m, PFS
Shimodate et al[15], 2014	M	79	Body	3.0	T1bN0M0, IA	NA	NA	Body	1.3	V-L	+	+	NA
Khoshnevis et al[16], 2013	F	64	Pylorus	6.0	T4N0M0, IIIA	Diffuse	P, SRCC	Fundus, body	1.0	H	+	NA	4 m, PFS
Namikawa et al[17], 2016	M	58	Body	9.0	T2N1M0, IIA	Diffuse	SRCC	Body	21.0	H	NA	NA	4 m, PFS
Kaffes et al[18], 2002	M	78	Antrum	NA	T1N0M0, IA	Diffuse	P	Body	1.5	ND	NA	+	20 m, PFS
Uchiyama et al[19], 2007	M	74	Antrum	1.5	T1aN0M0, IA	Intestinal	M-P	Body	0.8	L	+	+	NA
Salemis et al[20], 2008	F	78	Antrum	6.5	T4N2M0, IIIA	Diffuse	P	Body	1.0	L	+	+	14 m, DOD
Narasimhamurthy et al[21], 2010	M	65	Cardias	4.0	T4NxM0	Diffuse	P	Antrum	2.5	L	+	NA	NA
Ferreira et al[22], 2010	M	52	NA	10.2	T3N1M0, IIB	NA	NA	NA	1.1	V-L	+	+	NA
Ferreira et al[22], 2010	F	65	NA	4.8	T3N1M0, IIB	NA	NA	NA	0.7	V-L	+	+
Gonçalves et al[23], 2010	M	74	NA	NA	NA	NA	NA	NA	1.2	V-L	NA	NA	5 m, DOD
Gonçalves et al[23], 2010	M	67	NA	NA	NA	NA	NA	NA	0.3	V-L	NA	NA	2 m, DOD
Jeong et al[24], 2011	M	74	Antrum	3.3	T1aN0M0, IA	Intestinal	M	Body	2.0	V-L	+	+	NA
Cai et al[25], 2013	M	47	Cardias	8.0	T3N1M0, IIB	NA	P	Cardias	2.0	V-L	+	+	NA
	M	80	Antrum	2.0	T1N0M0, IA		P	Cardias	1.5	V-L	+	+
	M	60	Antrum	8.0	T3N0M0, IIA			Antrum	0.6	V-L	+	+
	F	67	Antrum	4.0	T3N1M0, IIB			Body	0.8	V-L	+	+
	M	78	Pylorus	6.0	T4N2M0, IIIA			Body	2.5	L	+	+
	M	78	Body	10.0	T3N1M0, IIB			Body	1.4	L	+	+
	F	59	Body	4.0	T2N1M0, IIA		P	Body	0.8	L	+	+
	M	80	Antrum	6.0	T2N0M0, IB		P	Body	5.0	L	+	+
Liszka et al[26], 2007	M	53	NA	NA	NA	NA	NA	NA	NA	V-L	+	NA	NA
Liszka et al[26], 2007	M	63	NA	NA	NA	NA	NA	NA	NA	L	+	NA
Yamamoto et al[27], 2012	M	67	Body	3.0	T4N0M0, IIB	Diffuse	P	Body	3.0	L	+	+	NA
Gülpınar et al[28], 2014	M	75	Antrum	NA	T1N1M0, IB	NA	M	Antrum	1.0		NA	NA	NA
Trihia et al[29], 2019	M	79	Cardias	8.5	NA	Intestinal	M-P	Body	0.9	L	+	+	Days, DOD
Yan et al[30], 2013	M	53	U	NA	T4N0M0, IIIA	NA	P	NA	0.4	V-L	NA		NA
	M	51	U	NA	T4N3M0, IIIB		M-P		0.8	V-L	+
	M	62	U	NA	T4N2M0, IIIA		P		0.8	V-L	NA
	F	73	L	NA	T4N3M0, IIIB		P, SRCC		0.2	V-L	NA
	M	68	M	NA	T1N0M0, IA		M		0.8	V-L	NA
	F	46	L	NA	T1bN0M0, IA		P, SRCCM		2.5	L	+
	M	78	U	NA	T4N1M0, IIIA		M		1.5	V-L	+
	M	66	U	NA	T4N3M0, IIIB		M-P		1.5	V-L	+
	M	85	U, M	NA	T4N2M0, IIIA		P		1.0	V-L	+
	M	68	L	NA	T4N0M0, IIB		M		0.8	V-L	+
	M	69	U	NA	T4N0M0, IIB		P, SRCC		2.0	V-L	+
	M	77	U	NA	T2N1M0, IIA		M		0.2	V-L	+
	M	71	L	NA	T4N3M0, IIIB		M-P		0.6	V-L	+
	F	77	L	NA	T4N3M0, IIIB		M-P		0.5	V-L	+
	F	70	L	NA	T1bN0M0, IA				0.6	V-L	+
Vogel et al[31], 2011	M	79	Body	6.0	T1N0M0, IA	Diffuse	P, SRCC	Body	0.8	V-L	+	NA	12 m, PFS
¹Ozgun et al[32], 2009	M	78	Body	NA	NA	NA	NA	Antrum	10.0	H	+	+
Hsiao et al[33], 2009	M	75	Cardias	1.0	T1N0M0, IA	NA	W	Cardias	3.3	L	+	+	6 m, DOD
Kountourakis et al[34], 2008	F	72	NA	NA	NA	Diffuse	NA	NA	1.8	V-L	+	+	6 m, PFS
Lee et al[35], 2007	M	82	Body	9.5	T4NxM1, IV	NA	NA	Body	1.5	L	+	+	NA
Chen et al[36], 2001	M	72	Pylorus	1.5	NA	NA	NA	Body	2.5	V-L	+	+	NA
¹Katsoulis et al[37], 2007	F	78	Cardias	NA	T4N3aM0, IIIB	Diffuse	P	Antrum	0.9	V-L	+	NA	NA
¹Liu et al[38], 2002	M	70	Cardia, fundus	8.5	T4N0M1, IV	Intestinal	NA	Cardia	NA	V-L	+	+	3 m, DOD
¹Toyoda et al[39], 2009	F	83	Body	9.0	T4NxM0	Intestinal	P	Body	4.5	H	+	+	6 m, DOD
¹Matsuno et al[40], 2021	M	68	Body	5.0	T3N0M0, IIA	NA	M	Body	0.5	V-L	+	NA	2.5 yr, PFS
¹Kleist et al[41], 2010	F	86	Body	6.0	NA	Intestinal	SRCC	Body	6.0	IN	+	+	11 m, PFS
¹Kleist et al[41], 2010	M	78	Body	6.0	NA	NA	SRCC	Body	5.5	IN	+	+	4 m, DOD
¹Trabelsi et al[42], 2008	M	54	NA	NA	NA	Diffuse	NA	NA	1.0	V-L	NA	NA	NA
¹Zámecník et al[64], 2005	F	93	Fundus	NA	LGIN, 0	NA	NA	Fundus	4.5	L	+	+	NA
¹Idema et al[43], 2008	M	71	Body	5.0	T4N2M0, III A	Intestinal	SRCC	Body	0.6	V-L	+	+	30 m, DOD
Alkaaki et al[65], 2018	M	55	Cardia	1.7	T1aNxM0	NA	NA	Antrum	10	H	-	+	NA
¹Bi et al[66], 2009	F	73	Fundus, body	4.0	T4N2M0, III A	Intestinal	W	Fundus	4	L	+	+	NA
¹Firat et al[44], 2010	M	63	Cardia	9.0	T4N3bM0, IIIB	Intestinal	NA	Cardia	0.4	V-L	+	+	13 m, DOD
¹Firat et al[44], 2010	M	60	Body	4.0	T1N0M0, IA	Intestinal		Body	0.5	V-L	+	+	12 m, PFS
Telugu et al[67], 2016	M	63	Cardia	4.0	T3N1M0, IIB	NA	M	Fundus	1.0	V-L	-	+	7 m, PFS
Lin et al[45], 2014	M (32), F (10)	> 60 (30), ≤ 60 (12)	NA	NA	IA (14), IB (8), IIA (5), IIB (1), IIIA (7), IIIB (4), III C (3)	NA	W (6), M (21), P (10), SRCC (5)	U (14), M (20), L (8)	≤ 2 (35), 2-5 (7)	V-L (35), L (4), IN (2), H (1)	+ (28)	+ (25)	3-yr (62.6), 5-yr (57.8%)
Liu et al[52], 2009	M (19), F (3)	64.5, (Med)	NA	NA	NA	NA	NA	Cardias (1), fundus (7), body (13), antrum (1)	0.8 (Med)	< L			5-yr (31.8%)
Present study	M (17), F (2)	62 (Med)	U (5), M (6), L (7), W (1)	3.5 (Med)	0 (1), IA (3), IB (3), IIA (3), IIB (3), III A (4), IIIC (2)	Diffuse (6), intestinal (5), mixed (3)	M-P (7), M (5), P (5), W (1)	Body (8), fundus (3), antrum (2), Cardia (2)	1.4 (Med)	L (10), V-L (7), H (2)	+ (19)	+ (18), - (1)	3-yr (73.9%), 5-yr (59.2%)
All	M (122), F (35)	70 (Med)	U (26), M (23), L (35)	4 (Med)	0 (2), IA (33), IB (16), IIA (17), IIB (13), IIIA (21), IIIB (11), IIIC (5), IV (2)	Diffuse (19), intestinal (23), mixed (3)	M-P (13), M (38), P (45), W (10)	U (43), M (66), L (20)	1.2 (Med)	V-L (84), L (35), IN (5), H (9)	- (2)	- (1)	3-yr (54.5%), 5-yr (46.7%)

¹Collision tumor.

GC: Gastric cancer; GIST: Gastrointestinal stromal tumor; M: Male; F: Female; Med: Median; DOD: Dead of disease; U: Upper one-third of the stomach; M: Middle one-third of the stomach; L: Lower one-third of the stomach; LGIN: Low-grade intraepithelial neoplasia; M-P: Moderately to poorly differentiated; M: Moderately differentiated; P: Poorly differentiated; W: Well differentiated; SRCC: Signet-ring cell carcinoma; V-L: Very low; L: Low; IN: Intermediate; H: High; SRCC: Signet-ring cell carcinoma; NA: Not assessed; PFS: Progression-free survival; pTNM: Pathological tumor-node-metastasis.

Citation: Liu J, Huang BJ, Ding FF, Tang FT, Li YM. Synchronous occurrence of gastric cancer and gastrointestinal stromal tumor: A case report and review of the literature. World J Gastrointest Oncol 2023; 15(10): 1807-1822
URL: https://www.wjgnet.com/1948-5204/full/v15/i10/1807.htm
DOI: https://dx.doi.org/10.4251/wjgo.v15.i10.1807