The remarkable discovery of a mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) post-gastrectomy represents a significant advancement in understanding and treating gastric cancers. A recent case report published in the Japanese journal of gastroenterology (Nihon Shokakibyo Gakkai Zasshi) presents the intriguing diagnostic journey of an elderly male patient with MiNEN, shedding light on this extremely rare and typically grim prognosis neoplasm. The article, titled “A case of mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) diagnosed by re-biopsy of the enlarged primary tumor during chemotherapy for gastric adenocarcinoma,” is set to press a new blueprint in the treatment protocols for gastric neoplasms.
Keywords
1. Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm
2. Gastric Cancer Treatment
3. MiNEN Diagnosis
4. Gastric Adenocarcinoma Chemotherapy
5. Neuroendocrine Carcinoma Management
Digital Object Identifier (DOI): 10.11405/nisshoshi.121.55
The Elucidation of an Exceptional Gastric Cancer Case
A 71-year-old man’s battle against gastric adenocarcinoma took a sharp turn when his primary gastric tumor unexpectedly enlarged during a standard regimen of chemotherapy, despite the metastatic lesions showing substantial reduction. Instead of indicating treatment failure, this anomaly led to a groundbreaking reevaluation, ultimately diagnosing the patient with MiNEN following a total gastrectomy. This patient’s journey, as detailed in the report by Fuchino et al., highlights the critical importance of timely re-biopsy in cancer treatment, and prompts a reconsideration of standard protocols when faced with atypical tumor behavior.
From Gastric Adenocarcinoma to MiNEN Diagnosis
The case reported in Nihon Shokakibyo Gakkai Zasshi concerns a 71-year-old man initially diagnosed with gastric adenocarcinoma, complicated by liver and para-aortic lymph node metastasis. His prescribed chemotherapy involved S-1 (an oral fluoropyrimidine), oxaliplatin (a platinum-based drug), and trastuzumab (a monoclonal antibody targeting HER2/neu receptors) – a combination frequently used to treat HER2-positive gastric cancers.
Unexpected Course of Treatment
The patient’s chemotherapy saw partial success, with a reduction in the size of metastatic lesions after six courses. However, the primary site in the stomach responded counterintuitively, indicating the possible development of chemo-resistance or emergence of a more aggressive tumor component. This prompted the medical team to perform a re-biopsy, which is not routinely conducted during chemotherapy unless new symptoms or significant clinical suspicions arise.
Re-Biopsy Reveals the Truth
The pathological analysis of the re-biopsy suggested a neuroendocrine carcinoma component, starkly different from the initial diagnosis. Following this revelation, a total gastrectomy was performed. The surgery and subsequent histopathological examination confirmed the diagnosis of MiNEN, a rare entity identified by the coexistence of both neuroendocrine and non-neuroendocrine neoplasms within the same tumor.
Second-line Chemotherapy and Its Efficacy
Post-surgery, a second-line chemotherapy regimen was initiated for the patient, which elicited a good response. The adaptation of the treatment protocol to the newly identified MiNEN facilitated effective management of the cancer, showcasing the vital role of re-evaluation in cancer therapy.
Discussion
The Rarity of MiNEN:
MiNEN is a rare gastric neoplasm category, defined by the World Health Organization as the presence of both neuroendocrine and non-neuroendocrine components, each comprising at least 30% of the tumor. Due to its rarity, there is limited literature on MiNEN, making each reported case crucial for expanding the collective medical knowledge and understanding of the disease’s diagnosis and treatment.
Importance of Re-Biopsy:
The significance of a re-biopsy can’t be overstated, especially when there’s an unusual or unexpected development in a patient’s response to cancer treatment. In the reported case, the decision to perform a re-biopsy was pivotal in offering the patient a targeted and more effective treatment approach that was responsive to the nature of MiNEN.
Advancements in Personalized Medicine:
This case report echoes the burgeoning field of personalized medicine in oncology, where therapies are tailored to individual patient profiles. The shift from a one-size-fits-all treatment paradigm to a more customized approach increases the precision and efficacy of cancer care.
Conclusive Insights:
The astute observations and decisive actions of the medical team led to the successful diagnosis and management of a patient with MiNEN. This case adds to the repository of knowledge on this neoplasm type and highlights the potential for proactivity and adaptability in current gastric cancer treatment practices.
Further Research Needed:
Despite this case’s contribution, further research into MiNEN’s biological behavior, optimal treatment strategies, and prognostic factors is imperative to improve outcomes for future patients.
References
1. Japanese Society of Gastroenterology. (2024). “[A case of mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) diagnosed by re-biopsy of the enlarged primary tumor during chemotherapy for gastric adenocarcinoma].” Nihon Shokakibyo Gakkai Zasshi, 121(1), 55-62. DOI: 10.11405/nisshoshi.121.55.
2. La Rosa, S., Marando, A., Sessa, F., & Capella, C. (2012). Mixed adenoneuroendocrine carcinomas (MANECs) of the gastrointestinal tract: an update. Cancers, 4(1), 11-30. DOI: 10.3390/cancers4010011.
3. Frizziero, M., Chakrabarty, B., Nagy, B., Lamarca, A., Hubner, R. A., Valle, J. W., & McNamara, M. G. (2019). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs): A systematic review of epidemiology, diagnosis, and treatment. Cancers, 11(4), 537. DOI: 10.3390/cancers11040537.
4. Rindi, G., Klimstra, D. S., Abedi-Ardekani, B., Asa, S. L., Bosman, F. T., Brambilla, E., … & La Rosa, S. (2018). A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) Expert Consensus Proposal. Modern Pathology, 31(12), 1770-1786. DOI: 10.1038/s41379-018-0110-y.
5. Milione, M., Maisonneuve, P., Spada, F., Pellegrinelli, A., Spaggiari, P., Albarello, L., … & Sessa, F. (2017). The clinicopathologic heterogeneity of grade 3 gastroenteropancreatic neuroendocrine neoplasms: A call for a personalized approach to clinical management. Oncologist, 22(7), 786-795. DOI: 10.1634/theoncologist.2016-0315.
Conclusion
The case report of this rare mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) serves as a testament to the evolving practices in gastroenterology and oncology, emphasizing the need for individualized patient care. As we delve deeper into the complexities of neoplasms like MiNEN, it becomes increasingly clear that adaptability, continuous research, and a personalized approach are fundamental to advancing cancer treatment and enhancing patient outcomes.