자궁경부 소세포암종의 방사선치료

정은지(Eun Ji Chung),이용희(Yong Hee Lee),김귀언(Gwi Eon Kim),서창욱(Chang Ok Suh) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : 자궁경부 소세포암종으로 진단되어 방사선치료를 받은 환자에서 조직병리학적인 재검사를 시행하여 조직병리학적 특성을 알아보고, 환자 및 종양의 특징, 방사선치료 후의 치료 성적 등을 조직병리학적 유형에 따라 후향적으로 비교 분석해 보았다. 대상 및 방법 : 1981년 10월부터 1995년 4월까지 연세의대 연세암센터 치료방사선과에서 자궁경부암으로 방사선치료를 받은 환자 총 2890명 중 조직학적 유형이 소세포암종이었던 환자는 60명으로 2.08%였다. 타병원에서 조직검사 및 병기 결정 후 방사선치료 만을 위해 전과되었던 36예에서는 자궁경부 생검 조직을 확보할 수 없었고, 이들을 제외한 24명에서 조직에 대한 병리학적 재검사가 가능하여 H & E 염색 및 신경내분비 표지인 neuron-specific enolase(NSE), chromogranin, synaptophysin, Grimelius 면역조직화학 염색을 시행하였다. 이들 24예의 환자 및 종양의 특성, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등을 후향적으로 분석하였다. 결 과 : H & E 염색 및 4가지 neuroendocrine marker 검사 후 13예는 신경내분비암종으로 진단되었고 11예는 소세포 유형의 편평상피암종으로 진단되어 병리학적으로 크게 2가지 군으로 분류하였다. 신경내분비암종으로 분류된 13예 중 5예는 중등도 이상으로 분화가 좋은 편이었으나 8예는 분화가 나쁘거나 미분화되었다. 전체 24예 대상 환자들의 연령은 23-79세로 중앙 연령치 54세였으며 FIGO 병기 분포는 Ib 8예(33.3%), IIa 1예(4.2%), IIb 11예(45.8%), IIIa 2예(8.3%), IIIb 1예(4.2%), IV 1예(4.2%)로 병기 I- II가 20예로 대다수를 차지하였다. 골반 림프절에 전이가 있었던 환자가 5예(20.8%) 있었는데 이 중 3예는 수술후 조직학적으로 확인되었고(2예는 근치적 수술, 1예는 골반 림프절 생검) 다른 2예는 전산화 단층 촬영상 골반 림프절이 커져 있어 전이로 판단되었다. 이들 2가지 병리학적 분류군에 따라 환자 및 종양의 특성을 비교해 보았는데 특별한 차이는 발견할 수 없었으며, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등의 치료 결과를 비교해 보았을 때 치료 실패 양상에 있어서 소세포형의 편평상피암종에서는 원격 전이가 2예(18.2%)인데 반해 신경내분비암종에서는 6예(46.2%)로 신경내분비암종(neuroendocrine carcinoma)에서 원격 전이율이 높았으나 환자 수가 적어 통계학적인 유의성은 없었다(P>0.05). 결 론 : 병리조직학적 재검사가 가능하였던 24예의 자궁경부 소세포암종 환자 중 13예가 신경내분비암종으로 진단되었으며 나머지 11예는 소세포형의 편평상피암종으로 분류되었는데 환자 및 종양의 특징, 방사선치료 성적을 비교해 볼 때 신경내분비암종에서 원격 전이가 호발하였으나(46.2% vs. 18.2%), 5년 생존율과 5년 무병 생존율의 차이는 없었다. 이런 결과로 자궁경부에서 발생한 소세포암종 중 신경내분비암종의 경우는 원격 전이가 많으므로 방사선치료, 수술 등의 국 소 치료와 더불어 적절한 항암화학요법을 추가하여 치료 결과를 증진시킬 수 있으리라 생각한다. Purpose : This study was performed to identify the histopathologic feature by the reevaluation of the pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. Materials and Methods : 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas (2.08%). Among them thirty six patients were transferred from other hospitals, the biopsy specimens of those patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin, synaptophysin and Grimelius stain). And we also evaluate the patients and tumor characteristics, response to radiation, patterns of failures, 5 year overall and disease free survival rates. Results : Thirteen tumors were neuroendocrine carcinomas (13/24=54.2%) and eleven tumors were squamous carcinomas, small cell type (11/24= 47.8%) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma. Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight patients had FIGO stage IB disease, 12 had stage II, 3 had stage III and one had stage IV disease. Pelvic lymph node metastases were found in five patients (20.8%), three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics, response to radiation, 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma patients (6/13:46.2%) than in small cell type of squamous carcinoma patients (2/11:18.2%), but there was no statistically significant difference because of the small number of patients (P>0.05). Conclusion : More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : 54.1%) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neuroendocrine carcinoma was greater than those of the small cell type of squamous carcinoma (46.2% vs. 18.2%). But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.

Gastric Adenocarcinoma with Coexistent Hepatoid Adenocarcinoma and Neuroendocrine Carcinoma -A Case Report-

김애리,배영경,김상운,송선교 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.1

This report represents a very rare case of a gastric adenocarcinoma that was coexistent with hepatoid adenocarcinoma and neuroendocrine carcinoma. A 77-year-old man was admitted to our hospital due to a huge ulcerofungating mass identified at the proximal body of the stomach. After a pathological diagnosis of the tumor as a poorly differentiated adenocarcinoma was made, the patient underwent a total gastrectomy with lymph node dissection. Microscopically, the tumor consisted of three morphologically distinct components-tubular adenocarcinoma, hepatoid adenocarcinoma and neuroendocrine carcinoma. The hepatoid denocarcinoma component resembled a he patocellular carcinoma and produced alpha-fetoprotein. The neuroendocrine carcinoma component was positive for chromogranin and synaptophysin immunostains. This is an example of the diverse morphological and immunophenotypical differentiation of gastric carcinomas. This report represents a very rare case of a gastric adenocarcinoma that was coexistent with hepatoid adenocarcinoma and neuroendocrine carcinoma. A 77-year-old man was admitted to our hospital due to a huge ulcerofungating mass identified at the proximal body of the stomach. After a pathological diagnosis of the tumor as a poorly differentiated adenocarcinoma was made, the patient underwent a total gastrectomy with lymph node dissection. Microscopically, the tumor consisted of three morphologically distinct components-tubular adenocarcinoma, hepatoid adenocarcinoma and neuroendocrine carcinoma. The hepatoid denocarcinoma component resembled a he patocellular carcinoma and produced alpha-fetoprotein. The neuroendocrine carcinoma component was positive for chromogranin and synaptophysin immunostains. This is an example of the diverse morphological and immunophenotypical differentiation of gastric carcinomas.

Morphologic Analysis of Pulmonary Neuroendocrine Tumors

이승숙,하승연,강명희,안정석,노미숙,하창원,한정호 대한병리학회 2013 Journal of Pathology and Translational Medicine Vol.47 No.1

Background: Few studies on how to diagnose pulmonary neuroendocrine tumors through morphometric analysis have been reported. In this study, we measured and analyzed the characteristic parameters of pulmonary neuroendocrine tumors using an image analyzer to aid in diagnosis. Methods: Sixteen cases of typical carcinoid tumor, 5 cases of atypical carcinoid tumor, 15 cases of small cell carcinoma, and 51 cases of large cell neuroendocrine carcinoma were analyzed. Using an image analyzer, we measured the nuclear area, perimeter, and the major and minor axes. Results: The mean nuclear area was 0.318±0.101 μm2 in typical carcinoid tumors, 0.326±0.119 μm2 in atypical carcinoid tumors, 0.314±0.107 μm2 in small cell carcinomas, and 0.446±0.145 μm2 in large cell neuroendocrine carcinomas. The mean nuclear circumference was 2.268±0.600 μm in typical carcinoid tumors, 2.408±0.680 μm in atypical carcinoid tumors, 2.158±0.438 μm in small cell carcinomas, and 3.247±1.276 μm in large cell neuroendocrine carcinomas. All parameters were useful in distinguishing large cell neuroendocrine carcinoma from other tumors (p=0.001) and in particular, nuclear circumference was the most effective (p=0.001). Conclusions: Pulmonary neuroendocrine tumors showed nuclear morphology differences by subtype. Therefore, evaluation of quantitative nuclear parameters improves the accuracy and reliability of diagnosis.

대장 신경내분비종양의 임상 경과와 병리 특징

정상훈 ( Sang Hun Jung ),김희철 ( Hee Cheol Kim ),유창식 ( Chang Sik Yu ),장흥문 ( Heung Moon Chang ),류민희 ( Min Hee Ryu ),이재련 ( Jae Lyun Lee ),김정선 ( Jung Sun Kim ),김진천 ( Jin Cheon Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.2

목적: 대장의 신경내분비종양은 매우 드물고, 통상적인 대장암에 비해 빠르게 진행하며 예후가 매우 나쁘다. 그러나 발생 빈도가 적어 국내에는 아직까지 보고가 없다. 이번 연구는 후향 분석을 통해 대장의 신경내분비종양의 임상 경과 및 병리 특징을 알고자 하였다. 대상 및 방법: 1997년 6월부터 2004년 12월까지 서울아산병원에서 H&E 및 면역조직화학염색에 의해 조직학적으로 대장의 신경내분비종양으로 진단 받은 13예의 환자를 대상으로 하였으며, 대장의 신경내분비암종 10예와 대장의 샘암종에 신경내분비분화를 포함하는 혼합암종이 3예였다. 카르시노이드 종양은 대상에서 제외되었으며, 환자들의 기록은 후향으로 조사하였다. 결과: 4,512명 중 13예(0.3%)의 환자가 대장의 신경내분비종양으로 진단되었다(신경내분비암종 10예, 혼합암종 3예). 환자 나이의 중앙값은 60세(41-83세)였으며, 남자가 6예, 여자는 7예였다. 종양의 발생부위는 직장 9예, 에스자결장 2예, 그리고 맹장과 횡행결장이 각각 1예였다. 면역조직화학염색을 시행한 신경내분비암종 9예 모두 synaptophysin 양성인 반면, chromogranin A는 3예에서 양성이었다. 6차 AJCC TNM병기에 따라 IIIB 병기 2예, IIIC 병기 3예 그리고 IV 병기가 8예였으며, 대장의 신경내분비암종 환자에서는 10예 중 7예에서 원격전이가 있었다. 신경내분비암종 10예와 혼합암종 3예의 중간생존율은 각각 16.4개월과 30개월이었다. 10예의 신경내분비암종 환자 중 항암치료를 받은 5예의 중간생존율은 III 병기 3예와 IV 병기 2예에서 각각 32개월과 17.5개월이었으나, 항암치료를 받지 않은 5예의 중간생존율은 6.2개월이었다. 혼합암종 3예는 모두 항암치료를 받았으며 중간생존율은 30개월이었다. 결론: 대장의 신경내분비종양의 빈도는 0.3%로 매우 드물다. 지금까지 적은 수의 환자와 빠르게 진행되는 종양의 특성으로 유용한 치료방침이 없었으나, 적극적인 병소의 절제와 etoposide/cisplatin을 이용한 항암치료 및 방사선치료는 환자의 생존율을 향상시킬 수 있을 것으로 기대한다. Background/Aims: Colorectal neuroendocrine carcinoma is a rare neoplasm exhibiting fulminant progression and having poor prognosis. The purpose of this study is to verify the clinicopathologic characteristics of colorectal neuroendocrine carcinoma. Methods: From June 1997 to December 2004 at Asan Medical Center, ten patients were originally identified as colorectal neuroendocrine carcinoma on the basis of H&E and immunohistochemical staining (IHC). Carcinoid tumors were excluded in this study. Medical records of thirteen patients were reviewed retrospectively. Results: Ten patients (0.2%) with colorectal neuroendocrine tumors were identified from 4,512patients with colorectal cancer; ten neuroendocrine carcinomas and three adenocarcinomas with neuroendocrine differentiation. Their median age was 60 (41-83) years. The subjects consisted of six males and seven females. Nine tumors were located in the rectum, two in the sigmoid, and each one in the transverse colon and cecum, respectively. Nine of ten neuroendocrine carcinomas expressed synaptophysin, but chromogranin A were expressed in four. All patients were advanced at the time of diagnosis, with AJCC TNM staging: stage IIIB (n= 2), stage IIIC (n=3), and stage IV (n=8). The median survival for ten neuroendocrine carcinomas and three adenocar-cinomas with neuroendocrine differentiation were 16.4 months and 30 months, respectively. Five patients who received chemotherapy showed median survival of 32 months (stage III) and 17.5 months (stage IV), whereas other five patients without chemotherapy died with a median survival of 6.2 months. Conclusions: Colorectal neuroendocrine tumors are extremely rare showing aggressive behavior biologically, i.e fulminant early distant metastasis. Nevertheless, improved survival may be achieved by aggressive multimodality therapy. (Korean J Gastroenterol 2006;48:97-103)

Primary Neuroendocrine Carcinoma of the Gallbladder : Case Report of Two Patients and Review of the Literature

Soon Wook Lee,Joo Hee Park,Seong Hee Kang,Hae Rim Kim,Ja Young Ryu,Jong Soo Lee,Yeul Hong Kim,Seung Tae Kim 중앙대학교 의과대학 의과학연구소 2012 中央醫大誌 Vol.37 No.4

Primary neuroendocrine carcinoma of the gallbladder (GB) is a rare type of neuroendocrine carcinoma. We report 2 cases of neuroendocrine carcinomas of the gallbladder. The first case was a 59-year-old man with GB mass and hepatic metastasis. The biopsy of hepatic mass confirmed grade 3 poorly differentiated neuroendocrine carcinoma. First line chemotherapy with etoposide and cisplatin, and 2nd line chemotherapy with pazopanib was done. The patient died of progressive disease 6 months after initial diagnosis. The second case was a 70-year-old man with a 10 cm huge GB mass with hepatic metastasis. The biopsy of hepatic mass confirmed a neuroendocrine carcinoma. The patient received a 1st line chemotherapy with etoposide and cisplatin. The 2nd chemotherapy with doxorubicin was started due to progression. The patient is receiving 5th cycle without progression 1 year after initial diagnosis. More randomized trial is needed to establish guideline for management of neuroendocrine carcinomas of the GB.

위선암을 동반한 폐 원발성 소형 신경내분비 세포암

이혜영 ( Hye Young Lee ),나소영 ( So Young Na ),백진옥 ( Jin Ok Baek ),노주영 ( Joo Young Roh ),이종록 ( Jong Rok Lee ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.4

Neuroendocrine tumors derive from the diffuse neuroendocrine system producing hormonal peptides and/or biogenic amines. Histologically neuroendocrine differentiation includes ultrastructural demonstration of neurosecretory granules and staining with immunhistochemical markers such as neuron-specific enolase, chromogranin, synaptophysin, and cytokeratin. Neuroendocrine carcinoma of the skin is rare but can be shown as an initial manifestation of metastatic neuroendocrine carcinoma as well as primary cutaneous neuroendocrine carcinoma. Histological differentiation between primary cutaneous Merkel cell carcinoma and metastatic neuroendocrine carcinoma of the skin is difficult and clinical correlation is important. We report a case of metastatic neuroendocrine carcinoma of the lung occurring on the scalp as a single nodule in a 65-year-old female who previously diagnosed with adenocarcinoma of the stomach. (Korean J Dermatol 2008;46(4):533~537)

Opportunities for 2-[18F] Fluoro-2-Deoxy-D-Glucose PET/CT in Cervical-Vaginal Neuroendocrine Carcinoma: Case Series and Literature Review

Yin Lin,Wan Y. Lin,Ji A. Liang,Yu Y. Lu,Hsin Y. Wang,Shih C. Tsai,Chia H. Kao 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.6

Objective: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan for the detection of this rare malignancy. Materials and Methods: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). Results: Two cases (cases 1 and 4) were restaged after 18F-FDG PET/CT scan in the initial staging process. Post-treatment 18F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. Conclusion: 18F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the 18F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the 18F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation. Objective: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan for the detection of this rare malignancy. Materials and Methods: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). Results: Two cases (cases 1 and 4) were restaged after 18F-FDG PET/CT scan in the initial staging process. Post-treatment 18F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. Conclusion: 18F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the 18F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the 18F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.

증례 : 대장에 발생한 대세포 신경내분비암종 1예

김희구 ( Hi Gu Kim ),이정일 ( Jung Il Lee ),정석 ( Seok Jeong ),이진우 ( Jin Woo Lee ),권계숙 ( Kye Sook Kwon ),김형길 ( Hyung Gil Kim ),신용운 ( Yong Woon Shin ),김루시아 ( Lucia Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.1

Neuroendocrine carcinoma of the colon can be classified into small cell carcinoma and large cell neuroendocrine carcinoma. The incidence of neuroendocrine carcinoma is so low that the guideline for the treatment of large cell neuroendocrine carcinoma of the colon are not established. The prognosis of large cell neuroendocrine carcinoma of the colon is worse than that of conventional adenocarcinoma of the colon. We report a case of large cell neuroendocrine carcinoma of the colon that treated with right hemicolectomy and 6th sequential combination chemotherapy of 5-fluorouracil and cisplatin. There has been no evidence of the recurrence or metastasis of tumor for 6 months. (Korean J Gastroenterol 2009;54:46-49)

Case Report : Hepatoid Carcinoma of the Pancreas Combined with Neuroendocrine Carcinoma

( Ji Ye Jung ),( Yoon Jae Kim ),( Hee Man Kim ),( Hong Jeoung Kim ),( Seung Woo Park ),( Si Young Song ),( Jae Bock Chung ),( Chang Moo Kang ),( Joo Yeon Pyo ),( Woo Ick Yang ),( Seung Min Bang ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.1

Hepatoid carcinoma is a primary extrahepatic carcinoma whose morphology, immunohistochemistry, and behavior are similar to those of hepatocellular carcinoma. The most common sites of extrahepatic carcinoma are the stomach and ovary, but nine cases of hepatocellular differentiation of the pancreas have been reported in the literature. We report another case of hepatoid carcinoma of the pancreas that was associated with the development of a pancreatic endocrine carcinoma in a 46-year-old man. Serum alpha-fetoprotein (AFP) was elevated to 262.49 IU/mL and radiological examinations revealed a mass measuring 7.5 cm in diameter in the head of the pancreas. He underwent a conventional Whipple operation, and light microscopy showed adenocarcinoma that was immunopositive for AFP, hepatocyte antigen, cytokeratin, chromogranin, synaptophysin, and alpha-1 antichymotrypsin. Although hepatoid differentiation was not shown unequivocally histologically, other immunohistochemistry findings supported the diagnosis of hepatoid carcinoma combined with neuroendocrine carcinoma. The patient was healthy and had no evidence of recurrence at 4 months after the surgery. This report describes why hepatoid carcinoma should be considered as a differential diagnosis of a pancreatic mass, especially when serum AFP is elevated. (Gut Liver 2010;4:98-102)

위선암과 대세포 신경내분비암으로 구성된 혼합종양

정진환,김용철,김정호,정대영,김진일,박수헌,김재광,정의성 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.2

A 55 year-old man was admitted with epigastric pain of one-month duration. We performed an esophagogastroduodenoscopy that showed the presence of a 3 cm sized polypoid mass at the lesser curvature side of the antrum. A biopsy demonstrated the presence of a neuroendocrine carcinoma of the stomach. A subtotal gastrectomy with D2 lymph node dissection was performed and the microscopic features of the resected specimen confirmed the diagnosis of a composite large cell neuroendocrine carcinoma with an adenocarcinoma of the stomach. A gastric neuroendocrine carcinoma is extremely rare and a composite neuroendocrine carcinoma with an adenocarcinoma of the stomach has been rarely reported. We report a case of a gastric composite tumor with an adenocarcinoma and a large cell neuroendocrine carcinoma. 55세 남자 환자가 한 달간의 상복부 통증을 주소로 내원하였다. 위내시경 검사에서 위 전정부 소만에 3 cm 크기의 폴립양 종괴 소견을 보였으며, 내시경 조직검사 결과 위 전정 소만부의 신경내분비암으로 진단되었다. 환자는 위 아전절제술 및 D2 림프절절제술을 시행하였으며, 최종적으로 수술 후 조직검사에서 선암과 대세포 신경내분비암의 혼합 종양으로 진단되었다. 위에서 발생하는 신경내분비암은 매우 드물며 위선암과 신경내분비암으로 구성된 혼합종양은 드물게 보고되고 있다. 저자들은 위에서 선암과 대세포 신경내분비암이 혼합 종양의 형태로 나타난 예를 경험하여 보고한다.