Carcinoid of the Operated Stomach: Difficulties in Diagnosis

Gastric neuroendocrine tumors commonly called carcinoids arise from enterochromaffin cells of the stomach and are rare. Recently, their incidence has increased, which may be due to the improvement of diagnostic and therapeutic capabilities. The article describes a rare clinical case of gastric carcinoid 23 years after surgical removal of gastric cardia cancer.

Successful endoscopic resection of an unusually enlarged and pedunculated type I gastric carcinoid tumour

Three distinct gastric carcinoid (GC) tumour types have been described based on differing biological behaviour and prognoses. Type I GC tumours account for the vast majority (70%–80%), are associated with chronic atrophic gastritis and have a low metastatic potential. Type II carcinoid tumours are the least common (5%–10%), are related to Zollinger-Ellison syndrome and occur in relation to multiple neoplasia type I. Sporadic type III tumours (15%–25%) are the most aggressive type, are unrelated to gastrin over secretion and carry the worst prognosis. In this case report, we present a patient with longstanding gastroesophageal reflux disease (GERD) who presented with epigastric abdominal pain and tarry stools and was found to have a large gastric polyp on endoscopy. Despite current literature recommending surgical resection for larger GC tumours, endoscopic resection was successfully used to excise the tumour with pathology demonstrating complete resection with negative margins.

A Comparison of Baseline Clinical Characteristics of Autoimmune Gastritis Patients with and without Type-1 Gastric Carcinoid Tumor

Objectives : Autoimmune gastritis (AIG) is an antibody-mediated autoimmune disease and characterized by gastric parietal cell loss. Type-1 gastric carcinoid tumor (GCT) is a disease that mostly develops on the basis of AIG. The aim of this study is to determine similarities and differences of baseline clinical parameters between these two disorders. Methods: Patients diagnosed as AIG both without gastric carcinoid tumor (n:197) and with GCT (n:40) between 2004 and 2015 at Ankara University Faculty of Medicine, Department of Gastroenterology, were included in this analysis. Data of initial signs and symptoms, basal blood count-anemia parameters, laboratory investigations, serum gastrin levels, anti parietal cell antibody (APCA) status, serological helicobacter pylori (Hp) markers and serum chromogranine A (CgA) levels of patients were obtained, and baseline parameters of these disorders were compared Results: Patient groups were similar in age and gender. Hemoglobin, iron, total iron binding capacity (TIBC), ferritin, vitamin B12 levels, APCA and HpIgG positivity rates and concomitant autoimmune thyroid disease prevalence were also similar. Median gastrin level in AIG+GCT patients was significantly higher compared to the AIG without GCT (807 vs. 1307 pg/ml; p:0.006). ROC analysis revealed that a 1000 pg/ml threshold value for serum gastrin level is able to distinguish these two disorders with 65% sensitivity and 65% specificity rates (area under the curve: 0.65;p:0.006). The serum CgA level did not significantly differ between patient groups. Conclusion: High serum gastrin but not CgA levels may be useful in deciding which patients should be followed closely in AIG.

Cardioesophageal carcinoid: multidisciplinary approach to diagnosis

Cardioesophageal carcinoid is a rare neuroendocrine neoplasm. Diagnosis and treatment are especially difficult in case of proximal localization of the gastric lesion (in the region of cardia) which requires a complex multidisciplinary approach. The clinical presentation of gastric carcinoid is in most cases nonspecific, and the tumor is accidentally detected in endoscopic exa-mination for the pain syndrome, dyspepsia, anemia, etc. Thus, all said above makes tumors of cardioesophageal zone a rather actual problem. In this article, on an example of patient K., of 61 years of age, possibilities of a complex approach to diagnosis and treatment of a complicated case of cardioesophageal carcinoid are shown. Conclusion. Diagnosis of carcinoid tumors is difficult and requires a multidisciplinary approach. The algorithm of diagnostic search and treatment tactics should suggest an individual approach in each clinical case which permits to make a correct diagnosis and to successfully reali-ze a required complex of medical measures.