Persistent Type I Gastric Microcarcinoid in a Patient With Pernicious Anemia

Abstract

Introduction: An interesting presentation of pancytopenia caused by type 1 gastric carcinoid. Case Report: A 56-year-old male with distant history of type 1 gastric carcinoid presented to the emergency department with complaints of left-sided chest and exertional dyspnea for several months. Hemogram demonstrated pancytopenia. Pancytopenia was attributed to extreme pernicious anemia due to marked B12 deficiency. Upon admission, the patient was found to have a macrocytic anemia (MCV 106) with Hb of 5.3, methylmalonic acid, and homocysteine levels were both elevated. The patient’s chest pain was presumed to be secondary to symptomatic anemia. Upper endoscopy was performed as part of the anemia work-up and demonstrated flattened folds within the fundus and the body of the stomach. Random biopsies of the fundus were performed to rule out atrophic gastritis. Histopathology revealed gastric microcarcinoid in the setting of atrophic gastritis, negative for Helicobacter pylori organisms. Discussion: Gastric carcinoid can be divided into 3 types: type I (in the presence of atrophic body gastritis, ABG), type II (in the presence of Zollinger-Ellison/multiple endocrine neoplasia type I syndrome), and type III (sporadic carcinoids without any background pathology). This patient’s biopsies of the fundus revealed micro-carcinoid, which is a rarely described entity. There are no specific surveillance guidelines for type 1 gastric carcinoid tumors. Conclusion: Further data needs to be gathered, as well as long-term follow-up, to understand the pathologic potential of gastric micro-carcinoid. When encountering a patient with pernicious anemia, it is important to entertain a diagnosis of type 1 gastric carcinoid and perform upper endoscopy.