Single-incision laparoscopic antrectomy for type I gastric neuroendocrine tumor: a case report

Laparoscopic total gastrectomy for multiple type І gastric neuroendocrine tumours: a case report

Background. The gastric neuroendocrine tumours (G-NETs), arising from neuroendocrine cells within the stomach. Type I lesions are associated with chronic atrophic gastritis (CAG). Multiple G-NETs are rare. Purpose – of our report is to describe a rare case of multiple Type-I G-NETs. Material and methods. During routine gastroscopy in a 44-year-old female with history of CAG and anaemia, multiple (15–20) polyps of size 2–9 mm were found. Multiple biopsies were obtained. Histopathological examination with haematoxylin and eosin staining described these lesions as undifferentiated cancer. Repeated gastroscopy was done. The three biggest polyps (5–9 mm) were removed by snare polypectomy. Repeated histopathological examination was specific for G-NET. The neoplasm presented Ki-67 proliferation index of < 3%; Cytokeratin 18, Chromogranin A, Synaptophysin, INSM1 were positive in neoplasm cells. Laparoscopic total gastrectomy was done. The operative time was 255 min, and the blood loss was 50 ml. Histopathological examination of a surgical specimen revealed multiple, Grade 1 G-NET (fig. 1–3). All lesions are limited to the mucosa and submucosa of the stomach, the longest size of the largest tumour lesion is 5 mm, what corresponds to pT1(m). No signs of lymphovascular or perineural invasion were found (L0 V0 Pn0). 18 regional lymph nodes were examined, no metastases were detected (0/18, pN0). Edges of resections of the esophagus and duodenum without signs of tumour growth (R0). Outside of tumours, there were signs of chronic inflammation of the stomach mucosa, with intestinal metaplasia and mixed glandular atrophy, there are also foci of nodular hyperplasia of neuroendocrine cells. Conclusion. We reported a rare case of multiple type-I G-NETs (pT1N0M0) with pernicious anaemia due to autoimmune CAG. Laparoscopic total gastrectomy is a method of choice in treatment of such patients.

Management of Gastric Neuroendocrine Tumors: A Review

Gastric neuroendocrine tumors (G-NET) are rare tumors arising from enterochromaffin-like cells of the gastric mucosa. They belong to a larger group called gastroenteropancreatic neuroendocrine tumors and are classified as low, intermediate, or high-grade tumors based on their proliferative indices. They are further categorized into three subtypes based on their morphologic characteristics, pathogenesis, and behavior. Types 1 and 2 tumors are characterized by elevated serum gastrin and are usually multifocal. They typically occur in the setting of atrophic gastritis or MEN1/Zollinger Ellison syndrome, respectively. Type 2 tumors are associated with the most symptoms, such as abdominal pain and diarrhea. Type 3 tumors are associated with normal serum gastrin, are usually solitary, and occur sporadically. This type has the most aggressive phenotype and metastatic potential. Treatment and prognosis for G-NET is dependent on their type, size, and stage. Type 1 has the best prognosis, and Type 3 has the worst. This review discusses the presentation, workup, and surgical management of these tumors.