Synchronous Gastric Carcinoid and Gastric Adenocarcinoma with Plummer-Vinson Syndrome: A Case Report and Literature Review

Abstract

Synchronous gastric tumours, though considered rare are now being increasingly reported in literature. They can grow separately within the stomach or merge with each other (collision tumor) or can form a mixed (composite) type of tumor.We present here an unusual case of synchronous gastric carcinoid and adenocarcinoma on the background of chronic atrophic gastritis with associated postcricoid oesophageal web. Upper gastrointestinal (GI) endoscopy of this 60-yearold female, who was a known case of hypertension with ischemic heart disease, showed a postcricoid web and a polypoidal, nodular mass along with 2 to 3 separate small nodular lesions in the distal gastric body. Histolopathology and immunohistochemistry of the biopsies from the mass and nodular lesions confirmed moderately differentiated adenocarcinoma and carcinoid tumor respectively, with evidence of chronic atrophic gastritis and intestinal metaplasia. H.pylori was negative. Serum gastrin levels were elevated and antiparietal cell antibodies were positive. Laboratory investigations revealed iron deficiency anaemia. There was no lymphadenopathy or distant metastasis on CT abdomen and no symptoms suggestive of carcinoid syndrome. She underwent a total gastrectomy with local lymphadenectomy. Plummer-Vinson syndrome has been described with gastric tumors, but not with the synchronous ones. This might be the first case where it has occurred along with synchronous gastric tumors or might be just a chance occurrence.