Clin Endosc.  2015 Sep;48(5):431-435. 10.5946/ce.2015.48.5.431.

Multicentric Type 3 Gastric Neuroendocrine Tumors

• Lee SH
• Moon D
• Lee HS
• Lee CK
• Jeon YD
• Park JH
• Kim H
• Lee SK

• KMID: 2148556
• DOI: http://doi.org/10.5946/ce.2015.48.5.431

Abstract

A 50-year-old woman with incidentally detected multiple gastric polyps and biopsy-proven neuroendocrine tumor (NET) was referred to our hospital. More than 10 polypoid lesions (less than 15 mm) with normal gastric mucosa were detected from the gastric body to the fundus. The serum level of gastrin was within the normal limits. There was no evidence of atrophic changes on endoscopy and serologic marker as pepsinogen I/II ratio. Computed tomography of the abdomen and pelvis revealed no evidence of metastatic lesions. She refused surgery, and we performed endoscopic polypectomy for almost all the gastric polyps that were greater than 5 mm. Although the histological examination revealed that all the removed polys were diagnosed as NET G1, three of them extended to the lateral or vertical resection margins, while two exhibited lymphovascular invasion. A follow-up upper endoscopy that was performed 6 months after the diagnosis showed multiple remnant gastric polyps that were suggestive of remnant gastric NET.

Keyword

Neuroendocrine tumors; Stomach; Multicentric; Type 3

MeSH Terms

Abdomen
Diagnosis
Endoscopy
Female
Follow-Up Studies
Gastric Mucosa
Gastrins
Humans
Middle Aged
Neuroendocrine Tumors*
Pelvis
Pepsinogen A
Polyps
Stomach
Gastrins
Pepsinogen A

Figure

• 

  Fig. 1 Endoscopic findings. Esophagogastroduodenoscopy revealed multiple polypoid lesions (less than 15 mm) located on lower body to fundus of stomach with normal gastric mucosa (A, B). There was no evidence of atrophic gastritis in the antrum (C).

• 

  Fig. 2 Histological examination of the gastric neuroendocrine tumor. Hematoxylin and eosin staining (H&E stain) showed that tumor cells invaded into the submucosal layer (A, ×40). The tumor was composed of uniform cells with round or ovoid nuclei and scanty eosinopohlic cytoplasm, proliferating in a trabecular or glandular pattern, which were absent of mitotic count (B, ×100). Immunohistochemical stating for chromogranin A was diffusely positive (C, ×40). The Ki-67 labeling index was less than 1% (D, ×100).

• 

  Fig. 3 Follow-up endoscopic findings. Esophagogastroduodenoscopy after 6 months from diagnosis still showed multiple remnant gastric polyps.

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