Gastric collision tumors: an insight into their origin and clinical significance

Occult collision tumor of the gastroesophageal junction comprising adenocarcinomas with distinct molecular profiles

Collision tumors, characterized by the coexistence of two unique neoplasms in close approximation, are rare and pose diagnostic challenges. This is particularly true when the unique neoplasms are of the same histologic type. Here we report such a case where comprehensive tumor profiling by next generation sequencing (NGS) as well as immunohistochemistry revealed two independent adenocarcinomas comprising what was initially diagnosed as a single adenocarcinoma of the gastroesophageal (GEJ) junction. Biopsy of the esophageal portion of the GEJ mass showed a mismatch repair deficient tumor with loss of immunoreactivity for MLH1 and PMS2, while the biopsy taken from the gastric portion of the mass revealed a separate tumor with a discordant, non-overlapping, set of molecular alterations, including an EML4::ALK fusion, as well as intact MMR. This case illustrates one way in which NGS can reveal diagnoses such as collision tumor that are wholly unexpected based on clinical and histological grounds. Such diagnoses can have important implications for patient care, particularly in cases where there is discordance for targetable molecular alterations.

Gastric collision tumor of adenocarcinoma and MALT lymphoma: A rare case report and literature review

INTRODUCTION AND IMPORTANCE

Gastric collision tumors, characterized by the coexistence of two distinct malignancies within the same organ, are exceptionally rare. We report a case involving a gastric collision tumor composed of adenocarcinoma (ADK) and marginal zone lymphoma, diagnosed postoperatively. To date, only six cases of MALT lymphoma as part of gastric collision tumors have been published, highlighting the rarity of this association.

CLINICAL PRESENTATION

A 58-year-old male with type 2 diabetes and a family history of breast cancer presented with six months of anemia and epigastric pain. Endoscopy showed a 5 cm ulcerated, friable gastric mass, and biopsies indicated a low-grade tubular adenocarcinoma. Imaging revealed gastric wall thickening and lymphadenopathy. He received FLOT chemotherapy followed by total gastrectomy with Roux-en-Y reconstruction. Histopathology confirmed a gastric collision tumor with a minimal adenocarcinoma remnant and extensive MALT lymphoma.

DISCUSSION

Collision tumors are rare and present unique diagnostic and therapeutic challenges due to the coexistence of distinct malignancies. This case highlights the complexity of managing such tumors, as accurate diagnosis requires comprehensive histopathological analysis. The dual presence of adenocarcinoma and MALT lymphoma necessitated a tailored approach with FLOT chemotherapy and total gastrectomy. The patient's ongoing adjuvant chemotherapy emphasizes the need for vigilant, long-term follow-up to monitor for recurrence and potential metachronous malignancies.

CONCLUSION

Gastric collision tumors involving ADK and MALT lymphoma are rare and challenging. This case contributes to the limited literature on collision tumors, highlighting the necessity for comprehensive diagnostic and therapeutic strategies.

Solitary fibrous tumor of the prostate with accompanying low-grade prostate cancer

We present the rare case of a 51-year-old male diagnosed with a solitary fibrous tumor (SFT) of the prostate, along with a concurrent low-grade prostate adenocarcinoma (Gleason score 3 + 3, Grade Group 1). The diagnosis was confirmed by positive immunohistochemical markers, including CD34, BCL2, and STAT6, and molecular analysis showing a NAB2-STAT6 fusion. Following successful surgical management and the simultaneous diagnosis of a pulmonary relapse from a prior thyroid carcinoma, the patient remains under clinical surveillance. This is particularly significant given the patient's history of multiple tumors, including Hodgkin's lymphoma, papillary thyroid carcinoma, prostate cancer, and SFT.

Factors associated with heterochronic gastric cancer development post-endoscopic mucosal dissection in early gastric cancer patients

BACKGROUND

Endoscopic mucosal resection is an innovative method for treating early gastric cancer and has been widely used in clinical practice.

AIM

To analyze the factors associated with the development of heterochronic gastric cancer in patients with early gastric cancer who had undergone endoscopic mucosal dissection (EMD).

METHODS

A cohort of patients with early gastric cancer treated using EMD was retrospectively analyzed, and patients who developed heterochronic gastric cancer after the surgery were compared with those who did not. The effects of patient age, sex, tumor size, pathological type, and surgical technique on the development of heterochronic gastric cancer were assessed using statistical analysis.

RESULTS

Of the 300 patients with early gastric cancer, 150 patients developed heterochronic gastric cancer after EMD. Statistical analysis revealed that patient age (P value = XX), sex (P value = XX), tumor size (P value = XX), pathological type (P value = XX), and surgical technique (P value = XX) were significantly associated with the occurrence of heterochronic gastric cancer.

CONCLUSION

Age, sex, tumor size, pathological type, and surgical technique are key factors influencing the occurrence of heterochronic gastric cancer after EMD in patients with early gastric cancer. To address these factors, postoperative follow-up and management should be strengthened to improve the prognosis and survival rate of patients.

Collision Tumor of the Ovary Involving Sertoli-Leydig Cell Tumor and High-Grade Serous Carcinoma-Report of the First Case

We report a collision tumor in the ovary of a 60-yr-old woman composed of high-grade serous carcinoma and Sertoli-Leydig cell tumor. Collision tumors in the ovary are rare and to the best of our knowledge, combination of ovarian high-grade serous carcinoma and Sertoli-Leydig cell tumor has not been described before.

Case report: First case of early adenoid cystic carcinoma and squamous cell carcinoma collision cancer treated by endoscopic submucosal dissection

Background

Collision cancer, a rare tumor, rarely occurs in the esophagus. Most reported cases of esophageal collision cancers are advanced cancers that can only be treated with surgery or palliative chemoradiotherapy. Here, we report a rare case of collisional squamous cell carcinoma (SqCC) and adenoid cystic carcinoma (AdCC) that was detected in the early stages by endoscopy.

Case summary

A 66-year-old man presented with retrosternal pain after swallowing and underwent endoscopy. Pathological biopsy showed high-grade squamous intraepithelial neoplasia. The lesion was removed by endoscopic submucosal dissection (ESD) after magnification and endoscopic ultrasonography. Postoperative pathology proved that the lesion was collision cancer comprising SqCC and AdCC. After six months of postoperative follow-up, there was no recurrence of esophageal cancer.

Conclusions

We provided a case report related to the diagnosis and treatment of esophageal collision cancer, especially early collision cancer. More research is needed to provide insights into the management of collision cancers.

Case report: Tumor collision in the colon, adenocarcinoma – lymphoma

Introduction

Tumor collision is the cohesion in a time of 2 tumors in the same space or organ but of different cell lineage.

Presentation of case

72-year-old patient with a history of black stools, involuntary weight loss and moderate protein-calorie malnutrition, asthenia, and adynamia; with endoscopic studies with the finding of esophageal candidiasis that leads to taking a rapid test for HIV (human immunodeficiency virus) which is positive; CT (computerized axial tomography) of the abdomen is performed, showing thickening of the cecum and distal ileum, as well as striation of fat in the same area, findings related to a primary neoformative process, for which it is decided to carry out a right hemicolectomy laparoscopically with pathology that reports ulcerated moderately differentiated adenocarcinoma that invades up to the muscle layer, associated with lymphoid proliferation with immunohistochemical findings consistent with lymphoplasmablastic lymphoma, this is probably linked to his diagnosis of HIV, configuring the diagnosis of tumor collision; extension studies with no findings of metastatic neoplastic disease.

Discussion

Tumor collision is a rare entity, which implies failure in the genomic control and replication sites of different cell lines, which, due to their lineage, have different regulatory processes, all this occurring at the same time in the same tissue.

Conclusion

The casuistry for collision tumors is scarce; even in the reference centers for oncology, the treatment is challenging given the multiple variables to consider, the particularity of each case, and the scarce evidence on the subject.

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Tumor collision is the cohesion of two different tumors in the same space.

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It is a rare entity often diagnosed in surgery or by the pathologist

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Collision tumors pose a challenge in determining the prognosis of the patient

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As collision tumors are composed of two different tumors, the recommended treatment is to target the most aggressive neoplasm.

Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report

Introduction and Importance

Neuroendocrine carcinoma of the colon and rectum account for less than 1% of all colorectal malignancies. Here we report a case of a collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma.

Case presentation

A 46-year-old asymptomatic female with severe anemia was referred by her primary care physician for admission. Initial imaging showed several innumerable heterogenous hypodense lesions within the liver. Following a colonoscopy and the excision of a rectal mass, the histopathology report revealed a Collision tumor.

Clinical discussion

There are no specific clinical features or imaging findings. The diagnosis is made post operatively dependent on histopathology.

Conclusion

It is essential to report these cases to advance a further understanding of the behaviour of these tumors, in addition to develop evidence-based guidelines and treatment strategies.

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Collision tumors are rare consisting of 2 independent tumors co-existing.

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Diagnosis is post-operatively and dependent on histology.

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No current guidelines for treatment. Management focuses on the predominant tumor.

Preoperative Diagnosis Failure for a Rare Gastric Collision Tumor: A Case Report

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors of the gastrointestinal tract (GIT), usually occur as a solitary neoplasm. Inflammatory florid polyp (IFP) is a solitary rare benign lesion of the gastrointestinal tract, mainly occur in the gastric antrum, whose atypical presentation can mimic GISTs or other malignant tumors, therefore the synchronous occurrence of GISTs and IFP is extremely rare. We had a case of a 58-year-old man that was presented with recurrent epigastric pain and recurrent melena. Upper endoscopic examination revealed a large polypoid antrum polyp measured 7 cm at greatest dimension with focal ulceration. Clinical and radiological features did not reach the definite diagnosis until histopathological evaluation with immunohistochemical analysis was performed. Surgical intervention is recommended and partial gastrectomy was done with wide resection margins. Histological examination revealed two distinct GISTs and IFP parts presenting a collision tumor that showed spindle and epitheloid cells consistent with GISTs with histological features of florid polyp showed a characteristic perivascular onion-skin arrangement of spindle cells with dense chronic inflammatory infiltrate including eosinophils and lymphocytes. Immunohistochemical studies have been done and revealed an association between GISTs and IFP. To the best of our knowledge, this is the first case of a collision tumor consisting of a GIST and an IFP arising in the stomach. In conclusion, the gastrointestinal stromal tumor is the comments mesenchymal tumor of GIT and IFP is a rare benign lesion of GIT therefore association between GIST and IFP as a collision tumor is extremely rare.

Simultaneous presentation of orbital mantle cell lymphoma and endocrine mucin-producing sweat gland carcinoma

Mantle cell lymphoma is a rare malignancy to present in the orbit, comprising only 1-5% adnexal lymphomas. Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is an equally uncommon adnexal tumor of sweat gland origin that may present on the eyelid. Herein we present a case of a 77-year old man with no previous cancer history who presented with painless progressive left globe proptosis and an enlarging left upper lid margin lesion, ultimately determined upon biopsy to be simultaneous orbital mantle cell lymphoma with systemic involvement and isolated eyelid EMPSGC. The pathogenesis, clinical manifestation, and management for each rare disease entity are reviewed and concept of collision tumors is discussed.

Collision tumor: a colonic adenocarcinoma and a gastric adenocarcinoma

BACKGROUND

Collision tumors are defined as the juxtaposition of two histologically distinct tumors, which form a single mass, without histological mixing of the two tissues. They are extremely rare, especially in the digestive tract.

CLINICAL PRESENTATION

An 81-year-old patient was admitted for anemia, diarrhea and palpable abdominal mass. The colonoscopy showed a substenosing tumor of the transverse colon. On abdominal CT, the colonic mass invaded the stomach. After surgical treatment with transverse colectomy and associated partial longitudinal gastrectomy, pathological results showed that it was a collision between a primary gastric adenocarcinoma and a primary colonic adenocarcinoma.

CONCLUSION

We report a first case of collision tumor between a primary gastric adenocarcinoma and a primary colonic adenocarcinoma. Current knowledge on the subject is extremely limited.

Preoperatively diagnosed gastric collision tumor with mixed adenocarcinoma and gastrointestinal stromal tumor: a case report and literature review

Reports of gastric collision tumors, comprising adenocarcinoma and gastrointestinal stromal tumor, are extremely rare. Here, we report the case of a 68-year-old male who was diagnosed with a lower-body, moderately differentiated, tubular-type adenocarcinoma and submucosal tumor and underwent an elective D2 distal gastrectomy. The tumor cells of the gastrointestinal stromal tumor were positive for H-caldesmon and CD117, weakly positive for smooth muscle actin and DOG-1, and negative for desmin, S-100 protein, CD31, and AE1/AE3. The tumor had grown into a mixed form of adenocarcinoma and gastrointestinal stromal tumor. Thus, we report the first case of a preoperatively diagnosed collision tumor in the stomach consisting of adenocarcinoma and gastrointestinal stromal tumor.

Collision tumors of the lung: A case report of urothelial carcinoma metastasizing to renal cell carcinoma with heterotopic ossification

Collision tumors are rare entities that consist of at least two or more histologically and ontologically distinct tumor types within the same organ. It is still not well understood how collision tumors form; yet, three main theories have been proposed to explain the pathogenesis, including the “random collision effect,” “field cancerization,” and “tumor-to-tumor carcinogenesis.” Collision tumors have been encountered in various body organs, including the lung. They either consist of a metastasizing tumor colliding with primary cancer or distinct primary or metastatic cancers colliding together. Here, we describe a rare case of collision tumors of the lung that consists of two metastatic carcinomas, namely renal cell carcinoma and urothelial carcinoma of the bladder. We propose that the urothelial carcinoma disseminated into several pre-existing pulmonary metastases of renal cell carcinoma with heterotopic bone formation. The possible mechanisms underlying the development of this peculiar tumor are discussed.

A Rare Case of Recurrent Pituitary Collision Tumors

Pituitary collision tumors are sporadically reported and rare. We present a case of pituitary collision tumors with nonfunctioning pituitary adenoma (NFPA) and craniopharyngioma. In order to look for any common activated pathway, we examined WNT/β-CATENIN signaling activation, known to be involved in tumorigenesis in both craniopharyngioma and NFPA. We found nuclear accumulation of β-CATENIN protein and expression of LEF1 protein, markers of active β-CATENIN signaling in the craniopharyngioma but not in the pituitary adenomas. In our case, the NFPA is invasive macroadenoma, which is a frequently identified type of pituitary adenoma in collision tumor cases. Recurrence of this tumor was first observed after 8 years of follow-up. Based on this case, we suggest that pituitary collision tumors require long-term follow-up.

Mimics, pitfalls, and misdiagnoses of adrenal masses on CT and MRI

Due to the widespread use of imaging, incidental adrenal masses are commonly encountered. A number of pitfalls can result in misdiagnosis of these lesions, including inappropriate choice of imaging technique, presence of pseudolesions, and overlap of imaging features of different adrenal lesions. This article explores the potential pitfalls in imaging of the adrenal glands, on computed tomography and magnetic resonance imaging, that can lead to misinterpretation. Clues to correct diagnoses are provided to evade potential misinterpretation.

The Significant Influence of the Neuroendocrine Component on the Survival of Patients with Gastric Carcinoma Characterized by Coexisting Exocrine and Neuroendocrine Components

Background

Gastric adenocarcinoma patients with a neuroendocrine (NE) component are frequently observed in routine practice. Several previous studies have investigated the influence of a NE component on the survival of these patients; however, the results were inconsistent.

Methods

We retrospectively investigated a consecutive series of 95 gastric adenocarcinoma patients with a NE component and 190 gastric adenocarcinoma patients without a NE component. We adopted 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, and 90% as the cut-off proportions of the NE component, respectively, and analyzed the patients' overall survival according to the proportion of the NE component.

Results

The 1-, 3-, and 5-year actual survival rates of the patients with a NE component were 90.1%, 72.3%, and 67.2%, respectively, and for those without a NE component 94.2%, 79.3%, and 75.7%, respectively. The multivariate analysis showed that the patients with NE components >70% (HR: 2.156; 95% CI: 1.011, 4.597; p=0.047) and >90% (HR: 2.476; 95% CI: 1.088, 5.634; p=0.031) had significantly worse survival than those without a NE component. Only the diameter of tumors (>4.64 cm) (HR: 2.585; 95% CI: 1.112, 6.006; p=0.027) and pN3 (HR: 2.953; 95% CI: 1.051, 8.293; p=0.040) were independently associated with worse overall survival for gastric adenocarcinoma patients with a NE component (all p<0.05).

Conclusion

Gastric adenocarcinoma patients with a NE component >70% and >90% have significantly worse survival than those without a NE component. Only the diameter of tumors and the number of metastatic lymph nodes are independent prognostic factors for gastric adenocarcinoma patients with a NE component.

Collision and composite tumors; radiologic and pathologic correlation

The terms composite and collision tumors have been used interchangeably throughout radiological literature. Both composite and collision tumors involve two morphologically and immunohistochemically distinct neoplasms coexisting within a single organ. However, collision tumors lack the histological cellular intermingling seen in composite tumors. Composite tumors often arise from a common driver mutation that induces a divergent histology from a common neoplastic source while collision tumors may arise from coincidental neoplastic change. The purpose of this review is to provide an overview of abdominal composite and collision tumors by discussing hallmark radiographic and pathological presentations of rare hepatic, renal, and adrenal case studies. A better understanding of the presentation of each lesion is imperative for proper recognition, diagnosis, and management of these unique tumor presentations.

A unique tripartite collision tumor of the esophagus: A case report

RATIONALE

We report a unique case of a tripartite esophageal collision tumor consisting of three separate histologic types.

PATIENTS CONCERNS

Therapeutic dilemmas on the proper treatment of those rare neoplasms remain unanswered considering both proper surgical therapy and adjuvant therapy.

DIAGNOSE

In this paper, we report a unique case of a patient with a tripartite esophageal collision tumor consisting of a small cell carcinoma, an adenocarcinoma of medium differentiation and a signet ring cell carcinoma. Diagnosis is difficult as clinical presentation of the patient was undistinguishable from other, commoner tumor types.

INTERVENTIONS

The patient's diagnostic and therapeutic course along with available data on the collisions tumor's biological behavior and treatment are briefly discussed.

OUTCOMES

Esophagectomy is the best treatment options for these patients. Unique nature of this tumor demands aggresive oncologic treatment.

LESSONS

Collision tumors are rare neoplasms consisting of distinct cell populations developing in juxtaposition to one another without any areas of intermingling. Various cell types can be found. However, collision neoplasms of the esophagus combining adenomatous and neuroendocrine components are exceedingly rare, with only 5 cases described to date in the literature. Given their rarity, limited information is available on their tumorigenesis, biological behavior and clinical course. In general, these tumors are aggressive neoplasms and significantly affect patient treatment and prognosis.

Collision tumor of choriocarcinoma and small cell carcinoma of the stomach: A case report

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We detailed a collision tumor of gastric choriocarcinoma and small cell carcinoma.

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We found a clear colliding point between choriocarcinoma and small cell carcinoma.

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Immunohistochemical staining results of HER2 were different for the two components.

Introduction

Both gastric choriocarcinoma and small cell carcinoma are extremely rare, both accounting for approximately 0.1% of all gastric cancers. Therefore, simultaneous occurrence of gastric choriocarcinoma and small cell carcinoma is even rarer.

Presentation of case

An 84-year-old Japanese man was referred to our hospital with the chief complaint of dysphagia. Laboratory data showed iron deficiency anemia. Contrast-enhanced computed tomography of the abdomen revealed thickened wall of the stomach at the fundus and several enlarged abdominal lymph nodes. Upper gastrointestinal endoscopy showed a friable gastric tumor with necrosis in the gastric cardia extending to the abdominal esophagus. Small cell carcinoma was diagnosed based on pathological examination of biopsy specimens. The anemia, which was probably because of tumor bleeding, progressed despite repeated transfusion; therefore, a semi-urgent laparotomy was performed to control hemorrhage. Finally, total gastrectomy and lymph node resection were performed. Based on pathological findings, a diagnosis of collision tumor of choriocarcinoma and small cell carcinoma of the stomach was confirmed.

Discussion

When encountering large tumors with necrosis or hemorrhage in the stomach, the possibility of choriocarcinoma component should be considered. Moreover, when small cell carcinoma is morphologically suspected, even if slightly, additional immunohistochemical staining must be performed.

Conclusion

This report detailed an extremely rare case of collision tumor of choriocarcinoma and small cell carcinoma of the stomach.

Collision tumour of large-cell neuroendocrine carcinoma and adenocarcinoma in the stomach: A case report

Concurrence of adenocarcinoma and large-cell neuroendocrine carcinoma of the stomach is a rare condition. Here, we report a case of gastric collision tumour with large-cell neuroendocrine carcinoma and adenocarcinoma. A 71-year-old Peruvian man presented with nausea, epigastric pain, and weight loss for seven months. An Endoscopic evaluation revealed a huge ulcerative and infiltrative mass in the upper and middle third of the stomach. The patient underwent a D2 total gastrectomy. Microscopically, two separated and attached ulcerative lesions were recognised. The proximal to the cardial lesion showed neuroendocrine morphology and immunoreactivity for synaptophysin, and the other a moderated tubular adenocarcinoma Borrmann type III. Both lesions invaded serosa and lymph nodes metastases were found in 17 of 41 lymph nodes retrieved (one lymph node with neuroendocrine metastatic deposits).