Palabras clave
Carcinoma
Carcinoma anaplásico
Carcinoma indiferenciado
Cáncer gástrico
Resumen
Introducción: El carcinoma gástrico indiferenciado es tipo raro de cáncer que no muestra diferenciación hacia el adenocarcinoma o el carcinoma de células escamosas, con mal pronóstico, con un comportamiento clínico no establecido. El artículo revisa características clínicas, abordaje y tratamiento. Caso clínico: Mujer de 61 años, con tumor Siewert III. Su histopatología fue compatible con un tumor pobremente diferenciado y estudios de extensión cT3N1M0. Con un equipo multidisciplinario por una hemorragia persistente se llevó a gastrectomía total. Resultados: La paciente presentó una fístula de la anastomosis esofagogástrica que se trató con EndoVAC. La inmunohistoquímica final fue un tumor epitelial de muy alto grado, tipo carcinoma indiferenciado/anaplásico. Recibió adyuvancia con capecitabina y oxaliplatino; posteriormente presentó una progresión tumoral hepática. Falleció 6 meses después. Conclusiones: Es fundamental recopilar más casos como este en la literatura científica para mejorar la comprensión del comportamiento biológico y optimizar las estrategias terapéuticas.
1. Yusefi AR, Bagheri Lankarani K, Bastani P, Radinmanesh M, Kavosi Z. Risk factors for gastric cancer: a systematic review. Asian Pac J Cancer Prev. 2018;19(3):591-603.
2. Oliveros R, Morales R, Facundo H. Cáncer gástrico: una enfermedad prevenible. Estrategias para intervención en la historia natural. Rev Colomb Gastroenterol. 2019;34:177-89. https://doi.org/10.22516/25007440.394
3. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251):635-48. https://doi.org/10.1016/S0140-6736(20)31288-5
4. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660
5. Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci. 2020;21(11):4012. https://doi.org/10.3390/ijms21114012
6. Kushima R. The updated WHO classification of digestive system tumours—gastric adenocarcinoma and dysplasia. Pathologe. 2022;43(1):8-15. https://doi.org/10.1007/s00292-021-01023-7
7. Lazăr D, Tăban S, Sporea I, Dema A, Cornianu M, Lazăr E, et al. Gastric cancer: correlation between clinicopathological factors and survival of patients. II. Rom J Morphol Embryol. 2009;50(2):185-94.
8. Chiaravalli AM, Klersy C, Tava F, Manca R, Fiocca R, Capella C, et al. Lower- and higher-grade subtypes of diffuse gastric cancer. Hum Pathol. 2009;40(11):1591-9. https://doi.org/10.1016/j.humpath.2009.04.004
9. Chiaravalli AM, Klersy C, Vanoli A, Ferretti A, Capella C, Solcia E. Histotype-based prognostic classification of gastric cancer. World J Gastroenterol. 2012;18(9):896-904. https://doi.org/10.3748/wjg.v18.i9.896
10. Endo S, Nishikawa K, Yamada T, Nakagawa T, Fushimi H, Chihara T, et al. Our experience of treating undifferentiated gastric carcinoma: report of four cases. Surg Today. 2015;45(2):235-40. https://doi.org/10.1007/s00595-013-0793-0
11. Yamamoto M, Kobayashi Y, Ochiai M, Terasawa H, Mizumoto Y, Tsubota Y. A rapidly progressed case of undifferentiated gastric cancer (in Japanese with English abstract). J Jpn Surg Assoc. 2012;73:2847-51. https://doi.org/10.3919/jjsa.73.2841
12. Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised phase 2/3 trial. Lancet. 2019;393(10184):1948-57. https://doi.org/10.1016/S0140-6736(18)32557-1
13. Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D'Journo XB, et al. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG). Ann Surg. 2015;262(2):286-94. https://doi.org/10.1097/SLA.0000000000001098
14. Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182-8. https://doi.org/10.1111/his.13975
15. Benesch MGK, O'Brien SBL. Epidemiology of undifferentiated carcinomas. Cancers (Basel). 2022;14(23):5819. https://doi.org/10.3390/cancers14235819
16. Matsuzaki H, Ikeda K, Takaki M, Liu M. A case of undifferentiated gastric cancer (in Japanese with English abstract). Nihon Rinsho Geka Gakkai Zasshi. 2008;69(4):810-4. https://doi.org/10.3919/jjsa.69.810
17. Kościuch J, Zielonka TM, Ziółkowski B, Domagała-Kulawik J, Bogacka-Zatorska E, Chazan R. Breast carcinoma and anaplastic gastric carcinoma with pleural metastases in a patient after mastectomy 30 years ago. Pneumonol Alergol Pol. 2006;74(1):129-31. https://doi.org/10.5603/ARM.28087
18. Megumi K, Ishigami S, Yanagita S, Arigami T, Uenosono Y, Kurahara H, et al. Combination chemotherapy resulting in complete response of huge lymph node metastases in undifferentiated gastric cancer: case report (in Japanese). Gan To Kagaku Ryoho. 2010;37(7):1373-6.
19. Awazu M, Wakahara T, Ashitani H, Tsuchida S, Ueno N, Toyokawa A, et al. A case of undifferentiated gastric cancer that recurred with portal vein tumor thrombus (in Japanese with English abstract). Nihon Shokakibyo Gakkai Zasshi. 2015;112(8):1510-6.
20. Terayama H, Masuko Y, Horie T, Koike Y, Ozaki S, Sano S, et al. A case of undifferentiated carcinoma of the stomach with unusual lymph node metastasis (in Japanese with English abstract). J Sapporo City Gen Hosp. 1990;50:65-8.
21. Matsuzaka T, Ito K, Makihata T, Matsumoto M, Kubokawa M, Kubo H, et al. A case of gastric undifferentiated carcinoma (in Japanese). J Clin Exp Med. 2001;78:927-9.
22. Baba H, Fujiwara N, Nakamura H, Tanaka K, Kuwabara H, Tamai S, et al. Adjuvant chemotherapy of S-1 and CDDP for undifferentiated adenocarcinoma of the stomach (in Japanese with English abstract). Gan To Kagaku Ryoho. 2008;35(12):2051-3.
23. Takami K, Miura K, Kobayashi T, Moriya T, Shibata C, Kinouchi M, et al. Undifferentiated gastric cancer confirmed by detailed pathological studies: report of a case (in Japanese with English abstract). J Gastroenterol Surg. 2008;41(1):52-6. https://doi.org/10.5833/jjgs.41.52
24. Takashima K, Inoue T, Hirata K. A case of undifferentiated gastric carcinoma. Surgery. 2010;72:884-6.
25. Ueda K, Shinji Y, Kawazoe Y, Iwasaki Y, Naka T, Yamaue H, et al. Perforated undifferentiated gastric cancer with metastatic small intestinal tumors: a case report (in Japanese with English abstract). J Abdom Emerg Med. 2010;30(7):937-40.
26. Shitara K, Fukunari H, Kato T, Yoshino J, Nakajima Y, Okajima C, et al. A case report of gastric cancer consisting predominantly of undifferentiated carcinoma (in Japanese). Gan To Kagaku Ryoho. 2014;41(12):2266-9.
27. Ajani JA, D'Amico TA, Bentrem DJ, Chao J, Cooke D, Corvera C, et al. Gastric cancer, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2022;20(2):167-92. https://doi.org/10.6004/jnccn.2022.0008
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Derechos de autor 2026 Fredy Romaña Mosquera, Liliana Cuevas López, Elio Fabio Sánchez Cortés, Magda Jimena Vargas Díaz, Maria Carolina Martínez Galvis