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CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 207-209

Mucinous adenocarcinoma of stomach with multiple foci of calcification: Addition of a case and a review of literature


1 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
3 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. Rashmi Patnayak
Department of Pathology, Sri Venkateswara Institute Of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.241285

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  Abstract 


In gastric carcinoma, tissue calcification is rarely noted. Most of the adenocarcinoma cases with calcification described in literature are gastric mucinous adenocarcinoma. We present one such case of a 33-year-old female with a brief review of literature. The multiple foci of punctate calcification were visible in images, gross specimen, and also on histopathological examination. This is an addition of a case to the existing literature.

Keywords: Gastric adenocarcinoma, mucinous adenocarcinoma, punctate calcification


How to cite this article:
Patnayak R, Vijaylaxmi B, Narendra H, Jena A, Reddy GV. Mucinous adenocarcinoma of stomach with multiple foci of calcification: Addition of a case and a review of literature. J NTR Univ Health Sci 2018;7:207-9

How to cite this URL:
Patnayak R, Vijaylaxmi B, Narendra H, Jena A, Reddy GV. Mucinous adenocarcinoma of stomach with multiple foci of calcification: Addition of a case and a review of literature. J NTR Univ Health Sci [serial online] 2018 [cited 2018 Dec 18];7:207-9. Available from: http://www.jdrntruhs.org/text.asp?2018/7/3/207/241285




  Introduction Top


Mucinous carcinoma is a histological subtype of adenocarcinoma. In mucinous carcinoma, at least 50% of the tumor is composed of large pools of extracellular mucin in addition to neoplastic cells. Mucinous carcinoma is usually associated with a worse prognosis. It is more frequently diagnosed in the advanced stage and it is associated with more frequent local recurrence, serosal invasion, lymphatic and vascular invasion, lymph node metastasis, and distant metastasis.[1],[2]

Tissue calcification is rarely encountered within gastric cancer.[3] Mucinous adenocarcinomas are usually associated with calcification.[4] We report one such case adding to the existing literature.


  Case Report Top


A 33-year-old female presented with a difficulty of swallowing for 2 months. She had a complaint of vomiting after taking food. The vomits contained undigested food material. She had a palpable swelling of 4 cm × 3 cm below the left costal margin. Upper gastrointestinal endoscopy revealed an ulceroproliferative growth from the gastric part of gastro-esophageal junction extending into the stomach along lesser curvature. Contrast-enhancing computed tomography (CT) revealed irregular thickening of the stomach wall in the fundus, lesser and greater curvature showing heterogeneous enhancement on postcontrast study. Also noted are multiple calcific foci [Figure 1]. She underwent total gastrectomy with an excision of lower 4 cm of esophagus along with D2 lymph nodal dissection. The gross gastrectomy specimen revealed the ulcerative growth and multiple foci of calcification on cut section. The histopathology showed mucin-secreting adenocarcinoma with signet ring cells and metastatic deposits in lymph nodes. There were multiple foci of calcification noted within the tumor. The histochemical stains such as alcian blue highlighted the mucin and the presence of calcium by von Kossa stain [Figure 2].
Figure 1: (a and b) Pre- - and post-contrast computed tomography abdomen axial images showing thickened enhancing gastric wall with multiple calcific foci within. (c) Scanogram of computed tomography abdomen showing punctate calcific foci in the body and fundus of stomach

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Figure 2: (a) Cut section of the gastrectomy specimen showing punctate calcification. (b) Microscopic presence of calcification and mucin (H and E, ×100). (c) Extracellular mucin (Alcian blue, ×100). (d) Punctate calcification (Von Kossa, ×100)

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  Discussion Top


Extracellular mucin can be produced and secreted by adenocarcinomas in various organs. This extracellular mucinous material gives the appearance of malignant cells floating within a gelatinous pool. For the diagnosis of mucinous carcinoma, more than 50% of the tumor cells should retain extracellular mucin.[3],[4]

Mucinous carcinoma of the gastrointestinal tract is a rare subtype of adenocarcinoma. Usually, mucinous carcinoma is encountered in the stomach and colorectum. Prognosis of mucinous carcinoma is worse than nonmucinous carcinomas, as at the time of diagnosis, they are in an advanced stage and are associated with more depth of invasion, high lymph node metastasis, lymphatic and venous spread, and peritoneal metastasis.[3],[4]

Gastric mucinous carcinoma constitutes approximately 3% of all gastric cancers. Most gastric carcinomas are detected by endoscopy combined with biopsy. However, the diagnosis of mucinous carcinoma by biopsy alone is difficult as most mucinous gastric carcinomas are located predominantly in the submucosa and there is less mucosal involvement.[3]

Gastric carcinomas rarely exhibit tissue calcification. Majority of the cases reported in literature are of mucinous type.[1] One article by Hwang et al. had analyzed the CT findings of 13 cases of calcified gastric carcinoma, out of which 11 were of mucinous type.[4] Similar to the present case, the calcifications seen in these cases were of the punctate or miliary shape, and the size varied from 1 to 3 mm in diameter. The location of these calcifications was in the thickened gastric wall.[4],[5]

The possible mechanisms for the etiology of calcification in gastric carcinoma include: (1) Dystrophic calcification of necrotic or degenerative tissue; (2) ontogenic calcification due to glycoproteins in the mucin component of the tumor; and (3) metastatic calcification caused by hypercalcemia. In gastric cancer, ontogenic calcification is considered more likely due to the calcification of mucopolysaccharides in mucin.[3]

This is an additional case of calcification in mucinous adenocarcinoma identified by imageology and pathology.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zhang M, Zhu GY, Zhang HF, Gao HY, Han XF, Xue YW. Clinicopathologic characteristics and prognosis of mucinous gastric carcinoma. J Surg Oncol 2010;102:64-7.  Back to cited text no. 1
    
2.
Lee NK, Kim S, Kim HS, Jeon TY, Kim GH, Kim DU, et al. Spectrum of mucin-producing neoplastic conditions of the abdomen and pelvis: Cross-sectional imaging evaluation. World J Gastroenterol 2011;17:4757-71.  Back to cited text no. 2
    
3.
Ichiishi E, Kogawa T, Takeda S, Yanagida K, Yoshikawa T, Kondo M. Eight cases of gastric tumors with calcification. Intern Med 1995;34:1038-42.  Back to cited text no. 3
    
4.
Hwang HY, Choi BI, Han JK, Lee DH, Lee BH, Chung KB, et al. Calcified gastric carcinoma: CT findings. Gastrointest Radiol 1992;17:311-5.  Back to cited text no. 4
    
5.
Park MS, Yu JS, Kim MJ, Yoon SW, Kim SH, Noh TW, et al. Mucinous versus nonmucinous gastric carcinoma: Differentiation with helical CT. Radiology 2002;223:540-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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