Case Of Gastric Carcinoid Tumor Research Articles

腹腔鏡補助下幽門側胃切除術を行ったA型胃炎を伴う胃カルチノイドの1例

症例は56歳，男性．2009年12月検診で胃体上部小弯に潰瘍を指摘され上部消化管内視鏡検査施行．胃体部に糜爛，潰瘍瘢痕の多発，胃全体に1～3mm大の発赤の多発を認めた．病理所見では粘膜固有層にchromogranin A(+)，synaptophysin(+)，CD56(+)の細胞よりなるendocrine cell micronestの増生が見られた．検査上高ガストリン血漿（1,900pg/ml）を認め，I型胃カルチノイドの診断となった．2010年3月ガストリン分泌を下げる目的でLADGを施行．血中ガストリン値は術翌日31pg/mlと正常化．術後6カ月目の内視鏡検査で残胃の病変は消失し，現在も病変は認められない．本疾患は比較的稀で，今回は治療としてLADG（laparoscopy assisted distal gastrectomy）を施行し良好な結果を得たので報告する．

A case of gastric carcinoid tumor associated with atrophic gastritis treated by endoscopic submucosal dissection followed by eradication of <i>H. pylori</i> infection

A case of gastric carcinoid tumor associated with atrophic gastritis treated by endoscopic submucosal dissection followed by eradication of <i>H. pylori</i> infection

EN BLOC REMOVAL OF A GASTRIC CARCINOID TUMOR USING ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUES

Endoscopic submucosal dissection (ESD) has recently been applied to the resection of gastric submucosal tumors other than carcinoid tumors. We describe a case of gastric carcinoid tumor enucleated with ESD. An 82‐year‐old woman was referred for treatment of a gastric tumor. Upper gastrointestinal endoscopy revealed a solitary submucosal tumor in the greater curvature of the gastric body. We diagnosed a carcinoid tumor by histological examination of biopsy specimens. Endoscopic ultrasound revealed a hypoechoic mass in the submucosal layer. Neither lymph node nor liver metastasis was recognized. The serum gastrin level was normal, and this tumor was classified as a type III (sporadic) carcinoid tumor. Endoscopic resection was decided on considering her age, general status, and wishes. We used ESD techniques, because the tumor was too large to be resected by conventional endoscopic mucosal resection. En bloc resection was performed. Histological examination of the 13 × 19 × 11 mm resected specimen showed that the cut end was free of tumor cells. Type III carcinoid tumor is usually treated by surgical resection with lymph node dissection. However, in high‐risk elderly patients we consider ESD to be a therapeutic option for local control of gastric carcinoid tumors.

Operative Treatment of Gastric Carcinoid Tumor Presenting as Multiple Polyps: A Case Report

Gastric carcinoid tumor is a neoplasm that arises from enterochromaffine-like (ECL) cells in the gastric fundus. It is a rare disease that comprises less than 2% of all gastric neoplasms; however its incidence has been recently increasing. We experienced one case of gastric carcinoid tumor that was revealed to be multiple polypoid lesions. A 29-year-old female patient visited a hospital three years ago due to syncope. The blood hemoglobin was measured as 6.0 g/dl. Gastroscopy revealed multiple polypoid lesions with bleeding; therefore endoscopic clipping was performed. The polyps were diagnosed as carcinoid tumor via endoscopic biopsy. She was transferred to our hospital because of persistent iron deficiency anemia that was caused by bleeding at the gastric polyps. Gastroscopy revealed more than twenty various-sized polypoid lesions from the mid-body to the antrum. The blood hemoglobin level was 9.0g/dl. Total gastrectomy was performed under the diagnosis of gastric carcinoid tumor with bleeding. All of the gastric polyps were diagnosed as carcinoid tumors, and any metastasis to the regional lymph nodes was not found. Eighteen months after operation, the blood hemoglobin was increased to 12.8g/dl with no evidence of recurrence. Surgical resection should be considered for treating gastric carcinoid tumor with continuous bleeding.

Ossifying gastric carcinoid tumor containing bone morphogenetic protein, osteopontin and osteonectin

We report a case of gastric carcinoid tumor with ossification. A 47-yr-old man complaining of abdominal discomfort underwent gastrointestinal endoscopic examination, which revealed a submucosal tumor in his stomach. The tumor was extirpated by endoscopic enucleation. Histologically, the tumor was widely occupied by mature bone tissues, where scattered carcinoid tumor cell nests surrounded bone tissues or located in stromal areas. Immunohistochemically, the tumor cells were strongly positive for cytokeratin, chromogranin A, synaptophysin, neurofilaments and neuron-specific enolase, underscoring the diagnosis of carcinoid tumor. They also stained positive with markers of bone formation and differentiation, such as bone morphogenetic protein, osteopontin and osteonectin. There are only four cases in the world literature, including a current case of ossifying gastric carcinoid tumor, in which the excessive production of peptides promoting ossification was considered to be implicated in the unusual appearance of the bone.

Benign gastric carcinoid tumor with hypergastrinemia followed up for 12 years.

Gastric carcinoid tumors associated with chronic atrophic gastritis type A have been reported to show good prognosis, because invasion and metastasis are rare. We report a case of gastric carcinoid tumor associated with hypergastrinemia that showed no malignant changes for 12 years. A 15-year-old man with abdominal discomfort underwent endoscopic examination. A polypoid lesion was detected on the atrophic mucosa of the fundus, and was diagnosed as a carcinoid tumor. Serological examination revealed a high level of anti-parietal-cell antibody, suggesting that the patient had chronic atrophic gastritis type A. The tumor was treated by endoscopic mucosal resection. Follow-up examinations were performed for 12 years, but showed no recurrence. This case confirms that gastric carcinoid tumors associated with chronic atrophic gastritis type A may have a good prognosis.

A case of gastric carcinoid tumor associated with type A gastritis treated with distal gastrectomy.

A case of gastric carcinoid tumor associated with type A gastritis treated with distal gastrectomy.

A CASE OF GASTRIC CARCINOID TUMOR OCCURRED ELEVEN YEARS AFTER SUBTOTAL GASTRECTOMY

A case of gastric carcinoid tumor occurred eleven years after subtotal gastrectomy due to gastric ulcer is presented. A 62-year-old man visited the hospital because of tarry stool.Fluoroscopy of the remnant stomach revealed a sclerosed wall at the anastomosed site. An irregular elevated lesion around the site undergoing gastroduodenostomy and stenosis in the same region with rigidity were noted by endoscopy. The patient was diagnosed as having a poorly differentiated adenocarcinoma by endoscopic biopsy.Total gastrectomy combined with splenopancreotectomy was carried out and reconstructed with Roux-en Y method.Histologically it was a gastric carcinoid tumor in H0P0, ss. Lymphnode metastasis was found in the sub-pyloric region.It is considered that multiple gastric carcinoid occurring under some conditions such as pernicious anemia may directly result from continuous stimulation by gastrin, and hence, malignant change can not start in the remnant stomach after antrectomy. In terms of this, this case is rare.