Neuroendocrine carcinoma of stomach causing gastric outlet obstruction: a diagnostic dilemma

Abstract

Gastric neuroendocrine tumour (GNET), also known as carcinoids, are a very rare cause of gastric outlet obstruction and arise from entero-chromaffin like cells of the mucosa. They account for 0.2/1000001 population and 8.7% of all Gastrointestinal carcinoids. They are four types based on the degree of differentiation, cell of origin and other pathologic features. Type 4 GNET are referred to as neuroendocrine carcinoma accounting for <1% of GNET. They are aggressive, poorly differentiated, locally invasive tumours with metastatic potential. Hence, they require an aggressive approach in terms of surgery and multimodality adjuvant treatment. Our patient is an elderly hypertensive who had complaints of projectile vomiting over ten days associated with weight loss over the last two years. A diagnosis of gastric outlet obstruction was made, and she underwent a contrast CT scan and endoscopy twice, both being suggestive of malignancy involving the antrum region however, the endoscopic biopsy showed unremarkable histology. Subsequently, she underwent emergency laparotomy in which there was a hard growth palpable in the antrum for which distal gastrectomy, D1 lymphadenectomy and gastrojejunostomy were done. Post-op HPE was suggestive of neuroendocrine carcinoma, thus, depicting our difficulty with diagnosis based on pre-op biopsy report given its rarity.