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LETTER TO EDITOR
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 43-44

An unusual florid polypoidal presentation of gastric neuroendocrine tumor


Department of Pathology, National Institute of Pathology, ICMR, New Delhi, India

Date of Web Publication24-Jan-2018

Correspondence Address:
Dr. Sharma Shruti
National Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjmsr.mjmsr_22_17

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How to cite this article:
Siraj F, Shruti S. An unusual florid polypoidal presentation of gastric neuroendocrine tumor. Muller J Med Sci Res 2018;9:43-4

How to cite this URL:
Siraj F, Shruti S. An unusual florid polypoidal presentation of gastric neuroendocrine tumor. Muller J Med Sci Res [serial online] 2018 [cited 2022 Oct 2];9:43-4. Available from: https://www.mjmsr.net/text.asp?2018/9/1/43/223905

Dear Editor,

A 69-year-old man presented with abdominal pain, nausea, and gradually worsening abdominal distention for the past 4 months. The patient had a history of peptic ulcer disease for which he had been taking medications. Upper endoscopy performed showed numerous polypoidal lesions involving the entire stomach. Biopsy taken exhibited features of neuroendocrine tumor, G1. Laboratory investigations revealed mild anemia with a hemoglobin level of 9 gm/dl, high serum gastrin levels (1200 pg/mL, normal ≤200 pg/mL), and negative antiparietal cell antibody test. There were no symptoms to suggest Zollinger–Ellison syndrome or multiple endocrine neoplasia Type 1 (MEN-1). The patient underwent a contrast-enhanced computed tomography scan which revealed multiple polyps in the entire stomach [Figure 1]. He was recommended to undergo total gastrectomy. On gross examination, multiple sessile and pedunculated polyps with size ranging from 0.5 cm to 3.0 cm were seen replacing almost the entire stomach with a thin rim of normal mucosa in the periphery [Figure 2]. Cut section of the polyps was yellow [[Figure 2], inset]. Histological examination showed a submucosal tumor infiltrating muscularis propria. It was composed of nests and trabeculae of monotonous small round cells with finely granular cytoplasm and salt and pepper chromatin. Mitotic figures were rare [Figure 3]. Surrounding gastric mucosa showed features of chronic gastritis. On immunohistochemistry, tumor cells were positive for chromogranin A [[Figure 3], inset]. Thus, a diagnosis of multiple gastric neuroendocrine tumors, G1 was rendered. Postsurgery serum gastrin levels decreased to the normal range.
Figure 1: Coronal contrast-enhanced computed tomography image shows multiple polypoidal lesions in the entire stomach

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Figure 2: Gross pathology multiple polyps varying in size from 0.5 cm to 3.0 cm are seen replacing almost the entire stomach with a thin rim of normal mucosa in the periphery (star). Inset shows smooth, yellow cut surface of the tumor (arrow)

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Figure 3: Microscopic evaluation photomicrograph showing nests of monomorphic tumor cells with granular cytoplasm and salt and pepper chromatin (H and E, ×200). Inset shows tumor cells with cytoplasmic, granular positive staining for chromogranin A (IHC, ×200)

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Gastric neuroendocrine tumors are rare, constituting <1% of gastric tumors.[1] They are categorized into three subtypes based on pathogenesis and histologic characteristics. Type I is the most common and is associated with enterochromaffin-like cellular hyperplasia, hypergastrinemia, and chronic atrophic gastritis, with or without pernicious anemia. They have the best prognosis but may show recurrences. Type II tumors are the least common and are associated with MEN-1 or Zollinger–Ellison syndrome. Type III is sporadic, usually solitary and is not associated with hypergastrinemia. These represent about 13% of gastric neuroendocrine tumors, G1 and are clinically the most aggressive type.[1],[2] Our patient belonged to Type I category.

This case highlights an unusual florid polypoidal presentation of gastric neuroendocrine tumor.

Although multiplicity is known in Type I, the florid polyposis in our case was unique. Owing to the extensive involvement, total gastrectomy was recommended in the present case.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Postlewait LM, Baptiste GG, Ethun CG, Le N, Cardona K, Russell MC, et al. A15-year experience with gastric neuroendocrine tumors: Does type make a difference? J Surg Oncol 2016;114:576-80.  Back to cited text no. 1
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2.
Borch K, Ahrén B, Ahlman H, Falkmer S, Granérus G, Grimelius L. Gastric carcinoids: Biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg 2005;242:64-73.  Back to cited text no. 2
    
3.
Hou W, Schubert ML. Treatment of gastric carcinoids. Curr Treat Options Gastroenterol 2007;10:123-33.  Back to cited text no. 3
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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