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LETTER TO THE EDITOR
Year : 2013  |  Volume : 9  |  Issue : 1  |  Page : 162-163

Oncocytic adenocarcinoma of the stomach: Parietal cell carcinoma


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication10-Apr-2013

Correspondence Address:
Kavita Mardi
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.110354

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How to cite this article:
Mardi K. Oncocytic adenocarcinoma of the stomach: Parietal cell carcinoma. J Can Res Ther 2013;9:162-3

How to cite this URL:
Mardi K. Oncocytic adenocarcinoma of the stomach: Parietal cell carcinoma. J Can Res Ther [serial online] 2013 [cited 2019 Nov 19];9:162-3. Available from: http://www.cancerjournal.net/text.asp?2013/9/1/162/110354

Sir,

Parietal cell adenocarcinoma of stomach is a rare entity with 27 reported cases to date. [1],[2] Histologically these are well to moderately differentiated tubular adenocarcinoma with abundant eosinophilic granular cytoplasm, reactive with phosphotungstic acid hematoxylin (PTAH) and Luxol Fast Blue. The tumors grow mainly outside the mucosa and can macro- and microscopically be misinterpreted as leiomyoblastomas or lymphomas.

A 56-year-old male presented with chief complaints of weight loss, early satiety, and epigastric pain since 6 months. Physical examination was normal. Ultrasonography was suggestive of a malignant growth at the pyloric end of stomach (T4N1M0).Preoperativeserum level of carcinoembryonic antigen was raised (68 ng/ml) and the serum level of CA 19-9 was normal (24 U/ml). Patient underwent partial gastrectomy and on gross examination of the specimen there was an ulceroinfiltrative growth at the pyloric end of stomach measuring 7 × 5 × 1.5 cm in size. Cut section of the growth was gray white in color and was invading up to the serosa. Microscopic examination revealed tumor cells with abundant eosinophilic cytoplasm, enlarged vesicular nuclei with prominent nucleoli. These tumor cells were lining the variably sized glands and were arranged in cords, diffusely infiltrating the gastric wall in to the serosa [Figure 1] and [Figure 2]. The tumor cells were reactive with PTAH. One of the two lymph nodes resected from the omentum showed metastatic tumor deposits (T4N2M0).
Figure 1: Photomicrograph showing the nests and cords of tumor cells infiltrating the gastric wall (H and E, 20×)

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Figure 2: Higher magnification showing tumor cells with abundant granular eosinophilic cytoplasm (H and E, 40×)

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The positivity for Luxol Fast Blue and PTAH are not adequate for appropriate diagnosis, but might indicate the necessity for further examination. Immunohistochemical stains for antimitochondrialantibodies are strongly positive. Gastric parietal cell carcinoma would better be based on immunohistochemical reactivity with antiparietal cell antibodies. Cafferty et al., [3] reported positive staining for cytokeratin AE1/AE3, in a case with parietal cell carcinoma of the stomach. Rychterova et al.,[4] reported two cases, and found both keratins and epithelial membrane antigen negative in parietal cell tumors, and even in normal parietal cells. They found epithelial markers positive in other epithelial cells of the gastric mucosa, and concluded that the diagnosis should be based on electron microscopic findings. They further stated that cases even presenting with advanced disease have better prognosis than other histologic variants. Ultrastructurally the tumor cells are characterized by abundant mitochondria, tubulovesicles, intracellular canaliculi and intercellular lamina filled with undulated microvilli. [5] This histologic variant has been associated with better prognosis. [3] The survival, also with metastasesis long. [4]

The present case confirms typical features of parietal cell (oncocytic) adenocarcinoma described by others, such as extensive submucosal spreading while the lymph node involvement and metastatic deposits in the omentum are unusual findings of this report.

 
 > References Top

1.Takubo K, Honma N, Sawabe M, Arai T, Izumiyama-Shimomura N, Kammori M, et al. Oncocytic adenocarcinoma of the stomach: parietal cell carcinoma. Am J Surg Pathol 2002;26:458-65.  Back to cited text no. 1
    
2.Motta MP, Athanazio DA, Motta A, Studart E, Athanazio PR. Parietal cell (Oncocytic) adenocarcinoma of the stomach ina female patient: Superficial spreading and extensive nodal involvement. Int J Surg Pathol 2008;16:447-9.  Back to cited text no. 2
    
3.Gaffney EF. Favourable prognosis in gastric carcinoma with parietal cell differentiation. Histopathology 1987;11:217-8.  Back to cited text no. 3
    
4.Rychterova V, Hagerstrand I. Parietal cell carcinoma of the stomach. APMIS 1991;99:1008-12.  Back to cited text no. 4
    
5.Capella C, Frigerio B, Cornaggia M, SolciaE, Pinzon-Trujillo Y, Chejfec G. Gastric parietal cell carcinoma-a newly recognized entity: light microscopic and ultrastructural features Histopathology 1984;8:813-24.  Back to cited text no. 5
    


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