The first case of familial non-syndromic gastric neuroendocrine-adenocarcinoma in Iraq

Background: Gastric adenocarcinoma is the most important type of stomach cancers, and it is generally sporadic. However, about 10% of gastric adenocarcinoma occurs in familial pattern. The most important genetic causative factor in gastric adenocarcinoma is CDH1 germline mutations which cause the diffuse stomach cancer syndrome. Chen was probably the first to suggest the existence of neuroendocrine carcinoma of the stomach as a separate entity in 1988. Patients and methods: The case of the first Iraqi patient with familial mixed gastric neuroendocrine-adenocarcinoma in Iraq is described. Results: At the age of 46 years, a male patient who had strong history of gastric malignancy was diagnosed as havening stomach cancer during screening studies. His father who was himself a surgeon died at about the age of 62 years after he was operated, and found to have disseminated stomach cancer, and no surgical resection was made. The patient had two healthy younger brothers and two younger healthy sisters. A screening gastroscopy were performed also on one of his brothers and one of his sisters, and showed normal findings. The paternal grandfather died from disseminated stomach cancer, and his brother died from stomach cancer also. An initial microscopic examination of resected giant polyp on the body of the stomach showed moderately differentiated adenocarcinoma. However, further tests including serum chromogranin on resected area suggested a neuroendocrine tumor. Conclusion: Ikue Nonogaki and his research group were probably the first to report the occurrence of non-syndromic familial adenocarcinoma-neuroendocrine gastric cancer. This paper reported the occurrence of the first case of disease in Iraq which may be the fourth reported case in the world.