Endocrine Abstracts

Introduction: Among three types of gastric neuroendocrine tumors (GEPNETV) type 1 are most common. At the basis of the pathogenesis of type 1 is atrophic gastritis, which leads to achlorhydria and deficiency of intrinsic factor, resulting in G cell hyperplasia and hypergastrinaemia. Gastric endoscopy usually reveals the multiple and polypoid lesions (<1–2 cm) in the corpus. Five-year survival in these patients is not different from survival in the selected age group population. Type 1 GEPNET metastasizes very rare (2–5% of cases).

The aim of our study was to present atypical type 1 GEPNETV.

Case report: In the Department of Endocrinology we follow up 41 cases of GEPNETV, among them 30 of type 1. M.S., 33-aged male, in 2008 due to anemia and epigastric pain had gastroscopy. It reavealed three wide based polypoid lesions bigger than typical lesions (15–30 mm in diameter). In biopsy there was highly differentiated neuroendocrine tumor expressing chromogranin. Ki67 index <1%. In addition, atrophic gastritis was found. In abdomen CT and scintigraphy with somatostatin analogues (SS scintigraphy) no speciphic changes were found. Patient refused proposed surgery and for 1 year was lost for follow up. In the next gastroscopy in 2010 there were three polypoid lesions up to 30 mm in diameter, with similar biopsy to former examination. In 2011 total gastrectomy was performed. Histopatology revealed neuroendocrine cancer with metastases to the local lymph nodes. In postoperative SS scintigraphy no uptake of the tracer was found, patient is treated with somatostatin long acting analoque.

Conclusions: Atypical presentation of type 1 GEPNETV should increase our awareness and influence the treatment decision making.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.