Carcinoid of the stomach with giant duodenal ulcer

Abstract

M ERLING [1] in 1808 first described the neoplasms which are presently designated as carcinoid tumors. The term, carcinoid, was used by Oberndorfer [2] in 1907 to differentiate these tumors which run a benign course as compared to the usual malignant ones. Masson and Martin [3] in 1928 applied the name argentaffinoma to this group of tumors since they frequently contained cytoplasmic granules in the cells which reduced silver salts. It was not until 1952 that Biorck [4] reported an unusual case of the carcinoid syndrome in which a patient manifested flushing of the skin, pulmonary stenosis, and tricuspid insufficiency and who at autopsy was found to have a carcinoid tumor of the ileum with metastases to the liver. Many original investigations and additional clinical cases of this complex of symptoms now known as the carcinoid syndrome have been added to the literature. This syndrome according to Thorson [5] includes vasomotor changes of the skin, intestinal hyperperistalsis, bronchial spasm or asthma, psychosis, telangiectatic widening of small cutaneous veins, edema, anasarca, unusual endocardial lesions of the right side of the heart, and pellagra-like skin changes. The clinical symptoms vary markedly. The dramatic vasomotor changes are well recognized clues to diagnosis. Flushing usually begins in the face and spreads to the trunk and extremities, lasting from seconds to several minutes or even hours. In 1933 Vialli and Erspamer [6] discovered a substance called enteramine (5-hydroxytryptamine) which was later called serotonin by Rapport [7]. Systemic release of excessive amounts of serotonin by carcinoid tumors was reported by Lembeck [8] in 1953. The relation of the clinical symptoms to the hyperproduction of serotonin by these tumors and the presence of increased amounts of 5-hydroxyindoleacetic acid in the urine of the patients with carcinoid syndrome as an end product of the metabolism of serotonin are the most important recent discoveries leading to the physiologic understanding of this syndrome. However, questions still remain concerning the prognosis, treatment, and malignant nature of carcinoid tumors. Carcinoid tumors are chiefly found in the gastrointestinal tract; the appendix and the terminal ileum are the commonest sites. Other primary sites have been the ovaries, gallbladder, pancreas, mediastinum, and bronchus. These tumors may arise at any level of the gastrointestinal tract from the cardia to the rectum. The carcinoid syndrome occurs chiefly when the terminal ileum is the site of the primary tumor. The stomach is one of the less frequently involved areas. Von Askanazy [9] in 1923 reported the first two cases of gastric carcinoid as incidental autopsy findings. Since that time some seventy additional clinical and autopsy cases have been described in the literature. Gastric carcinoid rarely is associated with the carcinoid syndrome, only five cases being reported, and only two being diagnosed preoperatively. This paper describes a patient with a