We report 3 cases of gastric carcinoids with hypergastrinemia.
Gastric carcinoids originate from the foregut and are derived from enterochromaffin-like (ECL) cells, which are the main neuroendocrine cells in the gastric mucosa. Gastrin acts directly on ECL cells to induce hyperplasia, dysplasia, and, eventually, neoplasia or carcinoid [
A 60-year-old man, who suffered from cerebral palsy due to measles encephalopathy at the age of 6 months, became unable to eat and underwent gastroscopy. A round tumor was detected at the anterior wall of the middle gastric body, and biopsy revealed a carcinoid (Figure
(a) Gastroscopy showed a round tumor at the anterior wall of the gastric body. (b) The resected tumor was 2 cm in diameter.
(a) Histological examination of the partially resected tumor revealed carcinoid with muscularis propria involvement (H&E
(a) Follow-up gastroscopy revealed another polypoid lesion in the residual stomach. (b) Resected whole stomach. (c) Numerous endocrine cell micronests (arrows) were observed widely in the muscularis mucosae of the stomach (H&E,
A 67-year-old woman experienced epigastric pain and nausea for the past 2 months. Gastroscopy revealed lots of elevated lesions (all were less than 5 mm in diameter) in the whole stomach (Figure
(a) Gastroscopy revealed multiple elevated lesions at the whole stomach. (b) Pathological analysis of the tumors after antrectomy showed carcinoid consisted of uniform cells with round-shaped nuclei with rosette-like or nodular solid structure (H&E
Background gastric mucosa of the resected stomach was type A gastritis microscopically. (a) Atrophy of gastric glands in the mucosa of gastric body was shown (H&E
A 61-year-old man was asymptomatic except for severe anemia (Hb: 4.5 g/dl) that was detected at a medical checkup. Gastroscopy revealed a large gastric tumor near the esophagogastric junction (Figure
(a) Gastrcosopy revealed a large gastric tumor near the esophagogastric junction. (b) Total gastrectomy was performed, and the resected tumor was approximately 8 cm in diameter.
(a), (b) Microscopic findings of the resected specimen revealed that the tumor was comprised of poorly differentiated adenocarcinoma ((a) H&E
A gastric carcinoid is a relatively rare neoplasm. Previously, carcinoids have been classified according to the embryologic origin (hindgut, midgut, and foregut); a gastric carcinoid originates from the foregut. Recently, carcinoids have been categorized according to their pathobiological behaviors into 3 different types [
A type 1 gastric carcinoid is usually small, multifocal, and located in the gastric fundus with a low potential of malignancy [
There seems to be some differences in the characteristics of type 1 gastric carcinoids based on Japanese and Western reports. The incidence of gastric carcinoids is 2.4%–8.7% [
In Japan, total gastrectomy with lymph node dissection has been the preferred surgical procedure for multiple gastric carcinoids associated with type A gastritis. The merit of this procedure is that the fundic gland area, which could be the origin of the carcinoid and ECM, is completely resected along with excision of the majority of G cells. Okada et al. also suggested that total gastrectomy should be considered as one of the treatments for multiple gastric carcinoids with hypergastrinemia [
Some authors have recommended a conservative approach without removal of the tumors. Hosokawa et al. proposed a follow-up program without surgical resection for multiple gastric carcinoids that are associated with type A gastritis [
In the present study, we observed atrophic gastritis in all 3 cases. The development of adenocarcinoma or endocrine tumors in atrophic gastritis is widely documented [
We showed 2 cases of multiple gastric carcinoids and 1 case of a carcinoid-adenocarcinoma tumor. All 3 cases were diagnosed with atrophic gastritis, which is associated with an increased risk of gastric carcinoma. We could have selected antrectomy with wedge resection of the large tumor for case