SURGICAL TREATMENT FOR A MIXED ADENOCARCINOMA
NEUROENDOCRINE CARCINOMA (MANEC) OF THE STOMACH
Abraham Abdemur MD, Jorge Huaco MD MPH, Emanuele Lo Menzo MD PhD,
Samuel Szomstein MD, Raul Rosenthal MD
The Bariatric & Metabolic Institute, section of Minimally Invasive Surgery,
Cleveland Clinic Florida, Weston, FL, USA
Key words: Mixed Adenocarcinoma Neuroendocrine Carcinoma (MANEC)
Introduction:
Mixed glandular-neuroendocrine tumors are a subcategory of tumors first described in
1988 in the colon. Very few cases arising from the stomach have been described in the
literature. We present the case of a mixed adenocarcinoma neuroendocrine carcinoma
(MANEC).
Case Report:
An 84-year-old female with history of breast and bladder cancer presented with four
month history of weight loss, epigastric pain and iron deficiency anemia. She underwent
an upper endoscopy, which revealed a large 7-10 cm ulcerated, necrotic mass in the lesser
curvature of the stomach. The pathology returned as poorly differentiated
adenocarcinoma.
The patient underwent laparoscopic mobilization of the stomach, followed by laparotomy
and en-block total gastrectomy, distal pancreatectomy, splenectomy and omentectomy
with Roux-en-Y esophago-jejunostomy reconstruction.
Results:
There were no postoperative complications. The final pathology showed T4 N1 poorly
differentiated mixed adenocarcinoma with a high-grade neuroendocrine type of
carcinoma. The metastasis to the lymph node had neuroendocrine morphology.
Conclusion:
Mixed glandular-neuroendocrine tumors of the gastrointestinal tract are rare and only few
arise from the stomach. Complete surgical excision remains the standard of care. Whether
the long-term prognosis of a MANEC tumor is different from that of gastric
adenocarcinoma remains to be determined.