Presentation
Abdominal pain since 2 weeks.
Patient Data
A broad-based, arterial hyper enhancing lesion measuring about 2.4 X 2.3 cm is seen along the lesser curvature, just distal to cardia, with mild focal thickening of the wall. A prominent small adjacent feeder vessel is noted. Perigastric fat planes are maintained. Few more, sub cm size, similar lesions are seen in the fundus and greater curvature. Sub cm-sized enhancing peri gastric (para cardiac) lymph node is seen.
Sub cm-sized mesenteric lymph nodes are seen.
Biopsy from the lesion suggestive of well differentiated neuroendocrine tumor.
Case Discussion
A small fraction of stomach tumors are gastric neuroendocrine tumors accounting for less than 2% of all gastric neoplasms and representing up to 10% of all gastrointestinal neuroendocrine tumors 1, 2.
A stomach carcinoid tumor can be of three different kinds.
Type I carcinoid tumors are benign tumors of modest size that often develop when chronic hypergastrinemia and atrophic gastritis coexist. When polyps are seen in a patient with chronic atrophic gastritis, the radiologist should be made aware that type 1 stomach carcinoid tumors may be present 1.
Large and polypoid tumors, especially in patients with multiple endocrine neoplasia type I, Zollinger-Ellison syndrome, are characteristics of type II tumors with a predisposition to nodal metastasis 1.
Large, irregular, solitary tumors are seen in type III tumors that are prone to carcinoid syndrome, nodal, and hepatic metastases. local invasion and ulceration are common in this type 1, 2.
In order to identify any small mucosal masses, when these tumors are suspected, narrow collimation, IV glucagon, and double contrast CT with effervescent granules should be employed.
In patients with serum hypergastrinemia, the presence of numerous polyps in the fundus and stomach body should prompt endoscopy and raise the possibility of gastric carcinoid tumors 1.
Unable to process the form. Check for errors and try again.