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Emerging evidence indicates that deficient mismatch repair proteins can drive microsatellite instability, supporting a molecular mechanism for this disease. A 60-year-old woman presented with epigastric pain; pathology showed gastric adenocarcinoma, and biomarkers confirmed MiNEN. The neuroendocrine component was grade 2 with Ki 67 of 16.5%. Both MiNEN components lost MLH1 and PMS2, and the patient underwent D2 distal gastrectomy with adjuvant oxaliplatin/capecitabine chemotherapy.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/deficient-mismatch-repair-proteins-in-gastric-mixed-neuroendocrine-non-neuroendocrine-neoplasm-a-rare-case-report/378338/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/deficient-mismatch-repair-proteins-in-gastric-mixed-neuroendocrine-non-neuroendocrine-neoplasm-a-rare-case-report/378338.png","ImageObject",300,407,{"name":92,"@type":93},"Grenda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes gastric MiNEN difficult in diagnosis and treatment?","Question",{"text":112,"@type":113},"Gastric MiNEN is rare and has controversial diagnostic and treatment approaches. Its definition involves two mixed tumor components, which can produce heterogeneous clinical and pathological findings.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was MiNEN confirmed in the reported patient?",{"text":117,"@type":113},"Biomarkers including AE 1/3, synaptophysin, and chromogranin A were used to confirm the presence of a neuroendocrine component admixed with adenocarcinoma.",{"name":119,"@type":110,"acceptedAnswer":120},"Which mismatch repair proteins were lost, and what was the implication?",{"text":121,"@type":113},"Both components lost MLH1 and PMS2 proteins. The findings support a deficient mismatch repair (dMMR) mechanism that may be associated with microsatellite instability and disease behavior.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},378338,1790330891,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},7971474921005,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Case Reports in Oncology  \n\n| Case Rep Oncol 2023;16:1172–1182 |  |\n| --- | --- |\n| DOI: 10.1159/000533707\u003Cbr>Received: July 25, 2023\u003Cbr>Accepted: August 16, 2023\u003Cbr>Published online: October 17, 2023 | © 2023 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([http://www.karger.com/Services/OpenAccessLicense](http://www.karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nCase Report  \nDeficient Mismatch Repair Proteins in Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasm:  \nA Rare Case Report  \nThi Hong Chuyen Nguyen a Bao Song Nguyen Tranb Thanh Phuc Nguyen c Thi Minh Thi Had Nguyen Cuong Phame Thu Giang Thi Nguyena Huu Hoanga Thuan Dang Congb  \na Department of Oncology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; b Department of Histology, Embryology, Pathology, and Forensic Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; c Department of Anatomy and Surgical Training, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; d Department of Medical Genetics, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam; e Department of Pathology, Hue Central Hospital, Hue, Vietnam  \nKeywords  \nGastric mixed neuroendocrine non-neuroendocrine neoplasm · Microsatellite instability · Mismatch repair protein · Gastric cancer · Adjuvant chemotherapy  \nAbstract  \nMixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare type of gastric carcinoma with controversial diagnosis and treatment. Recent data implies that deficiency mismatch repair proteins inducing microsatellite instability are considered one of the potential drivers of this disease. Hence, we report a stomach MiNEN with MMR protein loss. An admitted 60-year-old woman complained of epigastric pain. The pathological analysis of the gastroendoscopic biopsy specimen revealed gastric adenocarcinoma. The radiological staging was cT3N1M0; therefore, she received D2 distal gastrectomy. Suspecting neuroendocrine component admix with adenocarcinoma part on the resected specimen microscopy, applying biomarkers including AE 1/3, synaptophysin, and chromogranin A to confirm the diagnosis of MiNEN. The neuroendocrine part was classified as neuroendocrine tumor grade 2 with Ki 67 at 16. 5% . To further understand the molecular characterization of this disease, we evaluated mismatch protein expression by staining MLH1, MSH2, MSH6, and PMS2 antibodies. Interestingly, both components lost MLH1 and PMS2 proteins. Her radical surgery followed oxaliplatin/capecitabine adjuvant chemotherapy. The patient is still well after eight cycles of  \nCorrespondence to:  \nThuan Dang Cong, [dcthuan](dcthuan@ hueuni.edu.vn)[@](dcthuan@ hueuni.edu.vn)[ hueuni.edu.vn](dcthuan@ hueuni.edu.vn)  \nCase Reports in Oncology  \nCase Rep Oncol 2023;16:1172–1182 1173  \n\n| DOI: 10.1159/000533707 | © 2023 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n| --- | --- |\n\nNguyen et al.: Deficient Mismatch Repair Proteins in Gastric Mixed Neoplasm  \nchemotherapy. dMMR gastric MiNENs and dMMR gastric cancer share many clinical and genetic characteristics. Further studies are necessary to survey the role of dMMR in the prognosis and treatment of this entity.  \n© 2023 The Author(s) .  \nPublished by S. KargerAG, Basel  \nIntroduction  \nMixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) have been delineated in many gastrointestinal tract organs. The development of immunohistochemistry has contributed significantly to recognizing this tumor in clinical practice [1] . However, these neoplasms are very scarce, particularly in the stomach. The number of stomach MiNEN cases documented as of 2015 was less than 40 . Since 2015, the number of reports has increased, and case","cbCaid1iKT6PCKwG","https://ap.wps.com/l/cbCaid1iKT6PCKwG","pdf",1180539,11,"English","# Case Report\n## Background and rationale\n## Biomarker-based diagnosis\n## Molecular findings (MMR protein loss)\n## Treatment and follow-up","[{\"question\":\"What makes gastric MiNEN difficult in diagnosis and treatment?\",\"answer\":\"Gastric MiNEN is rare and has controversial diagnostic and treatment approaches. Its definition involves two mixed tumor components, which can produce heterogeneous clinical and pathological findings.\"},{\"question\":\"How was MiNEN confirmed in the reported patient?\",\"answer\":\"Biomarkers including AE 1/3, synaptophysin, and chromogranin A were used to confirm the presence of a neuroendocrine component admixed with adenocarcinoma.\"},{\"question\":\"Which mismatch repair proteins were lost, and what was the implication?\",\"answer\":\"Both components lost MLH1 and PMS2 proteins. The findings support a deficient mismatch repair (dMMR) mechanism that may be associated with microsatellite instability and disease behavior.\"}]","Deficient Mismatch Repair Proteins in Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasm - A Rare Case Report | PDF",1790229605,28]