t w t p i m s o E A man with a history of episodes of minor hematemesis presented to our department for treatment. here were no significant laboratory abnormalities, except for a ecreased hemoglobin level of 9.2 g/dL (normal, 13.2–17.2 /dL). Esophagogastroduodenoscopy revealed a well-circumcribed deep ulcerative lesion in the anterior wall of the gastric ntrum with irregularly elevated neighboring mucosa overlying 3-cm area of redundant gastric folds (Figure A). Further ork-up, including conventional chest, abdominal, and pelvic omputed tomography and colonoscopy, found no evidence of ny extragastric lesions. The patient subsequently underwent istal gastrectomy with systemic regional lymph node dissecion and Billroth I reconstruction. Macroscopic examination of he resected specimen revealed a lesion; the ulcerative tumor easured 3.5 3.5 cm in diameter with a slightly elevated rregular border. Microscopic examination showed diffuse proiferation of poorly differentiated, medium-sized tumor cells rranged in sheets or trabecular patterns with fine fibrous onnective tissue predominantly occupying the submucosa and he involved overlying mucosa without extension into the musularis propria (Figure B). The results of immunohistochemical nvestigations of the tumor cells showing positive immunotaining for chromogranin A and synaptophysin and a Ki-67 abeling index of 40% confirmed the diagnosis of neuroendorine carcinoma (NEC) (Figure C). There was no lymphatic or enous invasion, or lymph node metastasis. The patient is alive nd shows no sign of disease recurrence 8 months after the urgery. According to the most recent World Health Organization lassification (2010), neuroendocrine neoplasms of the digestive ystem encompass a diverse group of tumors that include the ollowing: (1) neuroendocrine tumors (equivalent to carcioids), which are well differentiated and are graded according o their proliferative activity as either G1 or G2; and (2) NECs, hich are poorly differentiated and are graded as G3.1 NEC of he stomach is an uncommon disease. It has strong malignant otential associated with an extremely poor prognosis because t invades the lymphatic and vascular lumens and frequently etastasizes to the lymph nodes and liver. Early NEC of the tomach is extremely rare and, to the best of our knowledge, nly a few early NECs of the stomach have been reported in the nglish literature.2,3 NECs of the stomach are classified as either pureor composite-type tumors. Although previously reported cases have been of the composite type, which contain an admixture of adenocarcinoma and NEC, the tumor in the present case was a pure-type NEC.