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CASE REPORT article

Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1463884

Successful conversion surgery after comprehensive therapy in a patient with MSI-H but pMMR metastatic gastric mixed adenoneuroendocrine carcinoma: A case report and literature review

Provisionally accepted
Jun He Jun He 1Li Wang Li Wang 2Chuanlei Tuo Chuanlei Tuo 3,4Weihua Gong Weihua Gong 1*Yong Liu Yong Liu 3,4*
  • 1 Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China
  • 2 Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China
  • 3 National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, Tianjin Municipality, China
  • 4 Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

The final, formatted version of the article will be published soon.

    Gastric mixed adenoneuroendocrine carcinoma (MANEC) is a rare and highly aggressive malignancy characterized by both exocrine and neuroendocrine components. Treatment options for metastatic cases are limited, with typical therapeutic approaches involving a combination of chemotherapy and immunotherapy. A 68-year-old male with metastatic gastric MANEC was treated with targeted therapy, immunotherapy, and chemotherapy, including S-1, apatinib, cadonilimab, and paclitaxel.After six cycles, the liver metastases resolved completely, and the primary tumor achieved partial remission, leading to conversion surgery. The patient underwent a radical D2 gastrectomy with R0 resection, including proximal gastrectomy, splenectomy, omentectomy, and esophagogastric anastomosis, along with radiofrequency ablation of liver metastases. Postoperative pathology confirmed the disappearance of liver metastases but revealed residual adenocarcinoma in the primary gastric lesion and neuroendocrine components in the perigastric lymph nodes. The patient was discharged seven days postsurgery. Five months postoperatively, new liver metastases were detected, exhibiting neuroendocrine differentiation. The patient was subsequently treated with a maintenance regimen of S-1 and pembrolizumab. This case highlights the significant heterogeneity of gastric MANEC and the challenges in managing such cases. While conversion surgery can be effective in certain contexts, the high likelihood of postoperative recurrence and metastasis, particularly in neuroendocrine components, necessitates cautious consideration. Further research is needed to evaluate the long-term benefits of conversion surgery in metastatic gastric MANEC and to develop tailored therapeutic strategies.

    Keywords: Gastric mixed adenoneuroendocrine carcinoma, Conversion surgery, targeted therapy, Immunotherapy, chemotherapy

    Received: 08 Aug 2024; Accepted: 25 Nov 2024.

    Copyright: © 2024 He, Wang, Tuo, Gong and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Weihua Gong, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China
    Yong Liu, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300070, Tianjin Municipality, China

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