Gastric carcinoid with hypergastrinemia: report of three cases

Abstract

We report 3 cases of gastric carcinoids with hypergastrinemia. Case 1: A 60-year-old man had a 2 cm carcinoid of the stomach and underwent partial resection. Involvement of the muscularis propria and lymph nodes metastasis were observed microscopically. Follow-up gastroscopy revealed another carcinoid lesion and total gastrectomy was performed. Case 2: A 67-year-old woman with multiple carcinoids of the entire stomach underwent antrectomy. No growth of residual tumors has been detected so far. Case 3: A 61-year-old man had a tumor near the esophagogastric junction and underwent total gastrectomy. Carcinoid component was diffusely intermingled with adenocarcinoma in the tumor and invaded into the subserosa. In all 3 cases, the serum gastrin level was high and atrophic gastritis was microscopically observed. Carcinoid tumor in Case 3 was different from those in Cases 1 and 2 and interestingly, gastric carcinoid with hypergastrinemia showed various types of appearance.

Figure 1

(a) Gastroscopy showed a round tumor at the anterior wall of the gastric body. (b) The resected tumor was 2 cm in diameter.

Figure 2

(a) Histological examination of the partially resected tumor revealed carcinoid with muscularis propria involvement (H&E ×4). (b) Carcinoid was consisted of uniform cells with round-shaped nuclei with ribbon-like structure (H&E ×40). (c), (d) The tumor cells showed immunoreactivity for synaptophysin (synaptophysin, (c) ×4, (d) ×40).

Figure 3

(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, ×4).

Figure 4

(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 ×40), (c) with submucosal invasion (H&E ×4). (d) The tumor cells were positive for chromogranin A staining (chromogranin A ×4).

Figure 5

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 ×4). (b) In the mucosa of antrum, no apparent atrophy of the pyloric glands was observed (H&E ×4). (c) Hyperplasia of gastrin-producing cells was detected (arrows) (gastrin staining ×4).

Figure 6

(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.

Figure 7

(a), (b) Microscopic findings of the resected specimen revealed that the tumor was comprised of poorly differentiated adenocarcinoma ((a) H&E ×40) with components of ECL cell carcinoid ((b) H&E ×40). (c) Carcinoid, immunohistochemically positive for chromogranin A staining (arrows), diffusely intermingled with adenocarcinoma (chromogranin A ×4). (d) Both carcinoid and adenocarcinoma invaded to subserosa (H&E ×4).