Coexistence of gastrointestinal stromal tumor and inflammatory myofibroblastic tumor of the stomach presenting as a collision tumor: first case report and literature review

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.

Gastric inflammatory myofibroblastic tumor: a case report

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) of the stomach is an uncommon mesenchymal neoplasm. We present a case of gastric submucosal tumor (SMT) where the final diagnosis was IMT.

CASE PRESENTATION

A 69-year-old man presented with a 24-mm SMT on the posterior wall of the middle third of the stomach that was detected by screening upper gastrointestinal endoscopy. Abdominal contrast-enhanced computed tomography showed that the tumor was well-enhanced. Although endoscopic ultrasonography-guided biopsy was performed, the histological diagnosis was not confirmed preoperatively. Since the tumor was clinically suspected to be a gastrointestinal stromal tumor, we performed gastric wedge resection by laparoscopic-endoscopic cooperative surgery. Pathologically, proliferative spindle cells with a positive reaction for smooth muscle actin, negativity for c-kit, desmin, s-100, CD34, STAT-6, β-catenin and anaplastic lymphoma kinase 1 were identified. Hence, the tumor was finally diagnosed as an IMT originating from the stomach.

CONCLUSIONS

When an SMT of the stomach is identified, the possibility of gastric IMT should be considered.

An Unusual Case of Collision Testicular Tumor in a Female DSD Dog

Collision tumors (CT) consist of two independent neoplasms with distinct neoplastic populations. Disorders of sexual development (DSDs) are characterized by atypical sexual development leading to various abnormalities of the genital tract. Sex reversal (SR) syndromes are a type of DSD characterized by a discrepancy between chromosomal sex and gonadal development (testes/ovaries) and the presence or the absence of the SRY gene. A phenotypically female 8-year-old Jack Russell terrier dog was referred due to anomalous vaginal discharge and non-pruritic cutaneous bilateral symmetrical alopecia on the flanks. During abdominal palpation, a voluminous mass was detected in the left quadrant area, later confirmed by ultrasound. The owner decided to proceed with euthanasia and necropsy. In the abdominal cavity, the left gonad was increased in size, the right one and the uterus were decreased, and the vagina and vulva appeared to be thickened. Histologically, both gonads were revealed to be testes: the left one was affected by a double neoplastic component (sustentacular tumor and interstitial cell tumor), whereas the right gonad showed coarctated seminiferous tubules. PCR amplification of the genes SRY and AMELX revealed the absence of the MSY region of the Y chromosome. To the authors’ knowledge, this is the first report describing a case of a testicular collision tumor in a DSD SRY-negative dog.

A case of neoplastic synchronism in a dog

INTRODUCTION

Synchronous primary tumors are considered severe, comorbid conditions in people representing neoplasm that develop independently and concomitantly. A diagnosis of synchronous tumors was made in a dog, underlying the difficulties to reach it without the aid of multiple diagnostic techniques aimed to demonstrate the simultaneous coexistence of different tumor types.

MATERIALS AND METHODS

A 7-year-old male Boxer dog presented several tumors located on the skin of the left hind limb and the scrotal region. Moreover, additional tumors in the testicles, after palpation and ultrasound examination, were detected. Following diagnostic results, the cutaneous tumor, scrotum, and testes were surgically removed.

RESULTS

Pathological investigations revealed the presence of five different tumors: a cutaneous mast cell tumor; a scrotal melanocytoma; three testicular neoplasms (Sertoli Sustentacular cell tumor, seminoma, and interstitial Leydig cell tumor).

CONCLUSIONS

The present report describes a neoplastic synchronism due to the presence of five different primary tumors in a dog and, for the first time the presence of a collision testicular tumor together with other non-testicular primary tumors. The occasional finding underlines the importance of the knowledge of such conditions in the process of decision-making and in carrying out all the proper diagnostic procedures for a correct diagnosis and clinical staging.

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.

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.

ALK Negative Inflammatory Myofibroblastic Tumor Synchronous with Classical Hodgkin Lymphoma

Inflammatory myofibroblastic tumor or inflammatory pseudotumor was first described by Brunn in 1932. Umiker et al. named it so in 1954 for its ability to mimic malignancy clinically and radiologically [Med Pediatr Oncol 2000; 35(5): 484–7]. This tumor, characterized by its rareness, affects mainly the lung and the orbit. Histologically, the tumor is characterized by the presence of fibroblasts, myofibroblasts, polymorphs, lymphocytes, and neutrophils. This case report and review of literature present a male patient, 37 years old, with a bulky mediastinal lesion at the topography of the 4th rib. Histopathology reveals Hodgkin's Lymphoma (HL) concomitant with inflammatory myofibroblastic tumor (IMT). This report aims to emphasize the relevance of differential diagnoses to a better medical assistance. To the best of our knowledge, a case with this characteristic has never been seen before.

Ovarian collision tumors: imaging findings, pathological characteristics, diagnosis, and differential diagnosis

Collision tumors are uncommon neoplasms in which elements of differing histologic origins coexist in a single mass. Ovarian collision tumors are a rare subtype of such lesions. The identification of collision tumors by radiologic examinations is essential to ensure that comprehensive biopsies are performed to guide appropriate treatments. According to the clinical and imaging findings of 12 patients and reviews of previous studies, ovarian collision tumors are mixtures of different combinations of epithelial tumors, germ cell tumors, and sex-cord-stromal tumors. The smaller tumors are usually located inside ("nested tumor") or on the wall ("back to back") of the larger tumors. Each type of ovarian collision tumors presents specific CT/MRI features in accordance with their histologic origins and collision patterns. Knowledge of the imaging features of ovarian collision tumors is crucial to aid preoperative diagnostic accuracy.

ALK-positive gastric inflammatory myofibroblastic tumor in an adult with familial adenomatous polyposis and diffuse fundic polyposis

BACKGROUND

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare in adults and exhibits a variable biological behavior that ranges from frequently benign lesions to more aggressive variants. Here we report a case of gastric IMT with lymph node metastasis in an adult who had undergone total colectomy for familial adenomatous polyposis (FAP).

CASE PRESENTATION

A 37-year-old man presented gradual-onset epigastric discomfort; he had undergone total colectomy for FAP 6 years before. The upper endoscopy revealed diffuse polyposis in the body of stomach and a submucosal protruding tumor of approximately 4.5 × 3.5 cm in the gastric angular incisure, appearing like gastrointestinal stromal tumor. Histology after surgery verified the diagnosis of fundic gland polyposis (FGPs) and gastric IMT with lymph node metastasis. Both the primary IMT tissue and its metastatic lesion but not the FGP or FAP tissue were positive for anaplastic lymphoma kinase (ALK) on immunohistochemical staining. Fluorescent in situ hybridization confirmed the existence of ALK rearrangement in IMT tissues. However, the patient exhibited no abnormalities in microsatellite instability or mismatch repair-system components, including MSH6, MSH2, MLH1 and PMS2, in IMT, FGP or FAP tissue.

CONCLUSIONS

This case allowed for exploring the relationship among IMT, FGP and FAP and indicates that gastric IMT should be considered in the diagnosis of a gastric mass in patients with FAP. ALK may be a useful biomarker in the diagnosis of IMT and its metastatic lesions.