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gastric carcinoid

Classification: 1) type 1 lesions (65%) - occur in the setting of chronic atrophic gastritis - generally identified as incidental finding on endoscopy for non-specific gastrointestinal signs & symptoms - gastrin from G-cells in the gastric antrum stimulate growth of type 1 gastric carcinoid 2) type 2 gastric carcinoid tumors occur in the context of ZE syndrome, MEN1, neurofibromatosis-1 3) type 3 gastric carcinoid tumors (20%) - unfavorable prognosis Epidemiology: - < 5% of carcinoid tumors Laboratory: - serum gastrin - in type 1, serum gastrin may be as high as 550 pg/mL [1] - serum gastrin elevated in type 2 - serum gastrin is normal in type 3 Special laboratory: - upper gastrointestinal endoscopy every 6-12 months for at least 3 years for small (<= 2cm) type 1 lesion [1] Complications: - metastasis - rare in type 1 - more common in type 3 Management: - endoscopic resection of small (< 1 cm) type 1 gastric carcinoid tumors with < 5 lesions is curative & further treatment or surveillance is unnecessary [1] - for type 1 gastric carcinoid tumors <= 2 cm - upper gastrointestinal endoscopy every 6-12 months for at least 3 years - 5 year survival > 95% - type 1 gastric carcinoid tumors > 5 cm - gastric antrectomy reduces G-cell mass that produces gastrin which stimulates growth of type 1 gastric carcinoid - type 2 gastric carcinoid tumors - octreotide is used for control of flushing & diarrhea that occur in the context of ZE syndrome or MEN1 associated with type 2 tumors [1] - type 3 gastric carcinoid tumors - total gastrectomy

General

carcinoid (argentaffinoma)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19. American College of Physicians, Philadelphia 2012, 2015, 2021
  2. Hwang JH, Rulyak SD, Kimmey MB et al American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006 Jun;130(7):2217-28. PMID: 16762644
  3. Crosby DA, Donohoe CL, Fitzgerald L et al Gastric neuroendocrine tumours. Dig Surg. 2012;29(4):331-48 PMID: 23075625 Free full text