Case Of Gastric Carcinoids Research Articles

Gastric neoplasms – An endoscopic biopsy study with review of literature

Background: Gastric cancer is the 2nd leading cause of cancer related deaths worldwide as most of the patients present very late during the course of the disease due to non-specific symptoms. Aims: To study the gastric neoplasms with reference to the age and sex occurrence, endoscopic presentation and histomorphology. Settings and Design: Descriptive study Methods and Material: The present study included biopsies of patients with suspected gastric malignancy at Kempegowda Institute of Medical Sciences, Bangalore, from January 2003 to January 2011. Brief clinical data were collected. Sections studied were diagnosed as per W.H.O classification and The Revised Vienna Classification of Gastrointestinal Neoplasia and the presence of any associated lesions noted. Results: The study included 163 gastric biopsies of which 157 were neoplastic. There was a male predominance with a peak in the 5th to 7th decade. The commonest site of origin was antrum and prepylorus (59.87%) and commonest endoscopic presentation observed was ulcerative growth (62.42%). Of the 157 neoplasms, 153 (97.45%) were adenocarcinomas. The other 4 cases comprised of 2 cases of gastric carcinoid, one case each of gastric lymphoma and GIST. The associated findings noted were H. pylori infection (22.87% adenocarcinomas), chronic atrophic gastritis (23.52% adenocarcinomas), intestinal metaplasia (9.15% adenocarcinomas), fungal infection and a hyperplastic polyp. Of the 163 biopsies, majority were grouped under categories 4 and 5 (61.34% and 29.44% respectively) of The Revised Vienna classification. Conclusions: Endoscopy with assisted biopsy is the gold standard for diagnosis of gastric cancer. A team approach towards treatment involving the pathologist and clinicians becomes crucial.

A Case of Multiple Gastric Carcinoid in a Woman with Systemic Lupus Erythematosus

Gastric carcinoid tumor is a rare neoplasm and it accounts for only 0.3% of all the gastric neoplasms. Gastric carcinoid tumor has high incidence in patients who are aged between 50 and 70 years, and it usually develops over a long period of time. Type I gastric carcinoid tumors are associated with autoimmune atrophic gastritis and pernicious anemia, and there are a few cases of gastric carcinoids in patients with other autoimmune diseases like Sjogren’s syndrome and autoimmune thyroiditis. Here, we report on a case of recurrent type I gastric carcinoid tumors in a 42-years old woman who suffered with systemic lupus erythematosus.

A case of gastric carcinoid with type A gastritis

A case of gastric carcinoid with type A gastritis

Lymph Node Metastasis From Gastric Carcinoid Tumors Occurring Concomitantly With Gastric Adenocarcinomas and Atrophic Gastritis

We describe a case of gastric carcinoids concomitant with gastric adenocarcinoma in a 50-year-old woman affected by atrophic gastritis. Number and size of the lesions, pathological examinations, and underlying gastric disease all indicated low-risk carcinoids. Nevertheless, when R1 gastrectomy was carried out, an unsuspected lymph node metastasis from carcinoid was found along the lesser curvature. The same occurrence is reported in several cases of the literature, which suggests that the association of gastric carcinoid to adenocarcinoma could point to the malignant nature of carcinoid, apart from underlying gastric disease and tumor characteristics.

Gastric carcinoids: a temporal increase with proton pump introduction

Recent reports have indicated a rising incidence of gastric carcinoids. This study aimed to evaluate the incidence pattern of gastric carcinoids in two large population-based cancer registries. The Florida Cancer Data System (FCDS), Florida's statewide cancer registry, and the Surveillance, Epidemiology, and End Results (SEER) program were used. The study population was defined as all cases of gastric carcinoid identified in either database from January 1981 to December 2000. Descriptive statistics and age-adjusted incidence rates were calculated. There were 326 (FCDS) and 594 (SEER) cases of invasive gastric carcinoid during the 20-year study period. The mean age of the patients was 65 years (range, 21-96 years), and the male:female ratio was 1:1. The age-adjusted incidence rate in FCDS increased from 0.04 (per 100,000 age-adjusted to the 2000 U.S. standard population) to 0.18 in the year 2000. The estimated annual percentage change in incidence was 8.17 in FCDS and 9.17 in SEER (p < 0.05). A decrease in gastric cancer was noted during this same period (from 8.64 to 11.14 cases per 100,000 in FCDS and from 11.14 to 8.06 cases per 100,000 in SEER). This study documented a statistically significant eight- or ninefold increase in the incidence of gastric carcinoids in two large databases. The temporal increase in incidence correlates with the introduction and widespread use of proton pump inhibitors since the late 1980s. Other explanations include improved detection with wider application of upper endoscopy. Further epidemiologic studies are warranted.

A CASE OF MULTIPLE CARCINOID TUMOR OF THE STOMACH IN WHICH BRONCHIAL ASTHMA DISAPPEARED AFTER A TOTAL GASTRECTOMY

A 62-year-old woman was found having type A gastritis and multiple carcinoids on the upper body of stomach on an endoscopic study. The patient was associated with bronchial asthma which initiated at the age 60. Urinary 5-HIAA and blood serotonin levels were normal. Each tumor was minite and it appeared possible to resect endoscopically. However, a total gastrectomy was counducted, because of her backgroung factors of type A gastritis and multiple occurrence, and a character of the disease that the tumor can invade the submucosal layer in an early phase. After the operation her asthma disappeared. A possibilty can be considered that the tumor in this patient might be positive for anti-histaminic antibody and bronchial asthma might arise from the tumor. And another possibility was thought that, since the tumor was minute, hypergastrinemia with gastritis type A might stimulate minute endocrine cell foci to provoke histamin production, inducing bronchial asthma. In a review of the Japanese literature as possible as we could, there have been no cases of gastric carcinoid in which associated bronchial asthma disappeared after the operation. This case which was thought valuable is presented here.

肝転移巣の破裂をきたした腺癌並存胃カルチノイドの１手術例

肝転移巣の破裂をきたした腺癌並存胃カルチノイドの１手術例

胃カルチノイドと早期胃がんが同一病巣内に共存した１例

胃カルチノイドと早期胃がんが同一病巣内に共存した１例

Carcinoids of the Gastrointestinal Tract

Thirteen cases of carcinoid of the GI tract during eleven years seen in our hospital are presented. Prior to surgery, the clinical diagnosis of our 9 cases of gastric carcinoid was as follows: 7 cases were diagnosed as advanced gastric cancer, one case as perforated gastric ulcer, while a minute lesion of less than 1 cm in diameter was correctly diagnosed as a carcinoid. The tumors were all larger than 2 cm in the largest diameter with the exception of a minute lesion that appeared as a submucosal tumor and was diagnosed correctly before operation. Only one case of rectal carcinoid was diagnosed as a carcinoid endoscopically. The other two were diagnosed as rectal polyp and rectal cancer respectively. The lesion arising in the cecum was diagnosed as cecum tumor. The biopsy specimens of most carcinoids revealed adenocarcinoma pre-operatively, and only two cases were diagnosed correctly as carcinoid. In our series, we were unable to detect any symptom or sign of carcinoid syndrome, even in the case with widespread liver metastasis. We have not encountered any case of carcinoid in the appendix, which lesion has been very frequently reported in the Western countries.

Carcinoid of the stomach with giant duodenal ulcer

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