S3055 Gastric Neuroendocrine Tumor Case Series in a Safety-Net Hospital in Long Island, NY

Abstract

INTRODUCTION: The incidence of gastric neuroendocrine tumors (NETs) have been on the rise as there are more EGDs being performed. In the US, the incidence went from 0.03 in the 1970s to 0.33 in the 2000s per 100,000. We present 3 cases from our GI clinic over the last 3 years and their respective management. CASE DESCRIPTION/METHODS: Case A: 51 year old hispanic female with hypertension presented with postprandial acid reflux. EGD revealed and removed a sub cm gastric nodule in the body with well differentiated neuroendocrine pathology. Gastrin level was 319. Followup EGD showed a 3 mm NET, which was again resected and subsequent EGDs showed normal histology at the site of removal. Octreotide scan did not show any metastasis. Case B: 59 year old African American female with sarcoidosis and endometrial cancer status post hysterectomy presented with food regurgitation and 20 lb weight loss. EGD revealed 10 cm mass at the GE junction extending to the body causing gastric outlet obstruction. Pathology showed poorly differentiated adenocarcinoma with neuroendocrine differentiation. MRI revealed metastasis to the liver. The patient had PEG tube placement and was started on palliative chemotherapy. Case C: 50 year old hispanic female presented with dyspepsia and microcytic anemia. Initial EGD was unremarkable. 2 years later, EGD done due to unresolved symptoms revealed 2.3 mm fundal polyp positive for well differentiated NET. Gastrin level was 801. Repeat EGD with multiple biopsies performed at the site of the NET revealed normal pathology. DISCUSSION: Gastric NET can be divided into 4 types. Type 1 and 2 develop as a consequence of hypergastrinemia. Type 1 is associated with atrophic gastritis while type 2 with Zollinger Ellinson syndrome. 5 year survival is >95% for type 1 and 70–90% for type 2. Tumors < 1 cm can be endoscopically resected. Patients A and C had type 1 and their tumors were removed at the time of diagnosis. The tumor returned for patient A, highlighting the significance of close surveillance. Type 3 and 4 are independent of gastrin and are invasive with high metastatic potential. They can be offered radical surgery but have poor survival rates. Type 4 histologically is gastric adenocarcinoma but with the presence of neuroendocrine cells as was found in patient B. Due to the metastatic extent, our patient was treated with palliative chemotherapy. Each of our patient’s management was individualized. We hope that their course can shed light to an emerging pathology.