CLINICAL REPORTS   

Chirurgia 1999 October;12(5):357-62

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Multiple gastric carcinoids. Problems of surgical strategy and case report

Turri L., Agugiaro S., Barbareschi M.

A clinical case of multiple gastric carcinoids in a woman of 70 with pernicious anemia is described. The author reviews the literature for the incidence of gastric carcinoids in patients with hypergastrinemia suffering from chronic atrophic gastritis (CAG)/pernicious anemia or with Zollinger-Ellison Syndrome (ZES). There is a practical usefulness of classifying 3 different types of gastric carcinoids: type 1­ associated with CAG/pernicious anemia (80% of gastric carcinoids); type 2­ associated with Zollinger-Ellisons s. in MEN1; type 3­ sporadic (without hypergastrinemia). The 3 types have a different prognosis and a different possibility of metastases and they need a different surgical approach, possibly with endoscopic tumorectomy or with gastric antrectomy in type 1 (correction of hypergastrinemia was found to induce regression of carcinoid tumours), but not if we have multiple gastric carcinoids with infiltration of the muscolaris mucosae. It is important to see the preneoplastic changes of the ECL ­ enterochromaffin-like cells of the extratumoral fundic mucosa too, for the typical sequence of hyperplasia-dysplasia-neoplasia of these cells in the hypergastrinemic patients.