A gastric collision tumor composed of adenocarcinoma and gastrinoma: case report

Collision tumors of the stomach are exceedingly rare, with only six previous reported instance in which adenocarcinoma of the stomach were found in association with carcinoid tumor. Only in one case the adenocarcinoma was associated with a gastrinoma. we report the second case of Collision tumor between adenocarcinoma and gastrinoma. A 55 years old man was admitted in our department for an exploration of gastric pain with rapid weight loss. Physical examination showed an epigastric mass. Upper endoscopy showed in the fundic region of the stomach an exophytic process wildly ulcerative in his center associated with the presence of a multiple polypoid tumors. The pathologic examination of the biopsy specimen of the process revealed an adenocarcinoma and of the polypoid tumors showed a carcinoid type tumor. There was no merged appearance between both tumors suggesting collision tumor. The biopsies of the non tumoral gastric mucosa were normal. The Zollinger Ellison syndrome was then suspected. The serum gastrin level showed a rate raised at 8676pg/ml. The diagnosis of collision type tumors between adenocarcinoma and gastrinoma was retained. The assessment of extension revealed the presence of hepatic and ganglion nodes. The patient was treated by chemotherapy but he died three months after initiation of chemotherapy because of tumoral progression. Through this observation and with a review of literature, the coexistence of adenocarcinoma and carcinoid tumor of the stomach is discussed.