Angeles-Angeles A

Language: Spanish
References: 16
Page: 207-214
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ABSTRACT

A Thirteen patients with primary endocrine neoplasm of the stomach were studied for 20 years. Six patients were male and 7 female with an age range of 33 to 77, mean age 57 years. Nine cases corresponded to well differentiated carcinoids and four to neuroendocrine carcinomas. Of the former, three were sporadic and six were associated with atrophic gastritis. These two forms of neoplasm showed important differences: those associated with atrophic gastritis had hypergastrinemia, all of the multiple small tumors confined to the corpus and fundus were well differentiated carcinoids associated with intestinal metaplasia and G cell hyperplasia in antrum and ECL cell hyperplasia in corpus and fundus. Tumors were clinically benign, with an excellent prognosis. All patients are currently alive with no evidence of neoplasm. In only one of these cases, antiparietal cell antibodies were documented; in three of them, extensive intestinal metaplasia probably due to Helicobacter pylori infection was found. In contrast, sporadic carcinoids were large isolated tumors originating in the antrum or corpus. Two patients died as a consequence of the neoplasm; all of them were moderately differentiated and in none of the cases we found evidence of endocrine hyperplasia . AII were positive for generic endocrine markers and were focally positive to some of the specific hormone markers. AII four neuroendocrine carcinomas had a clinical course similar to that of gastric adenocarcinomas and were poorly differentiated large tumors. We conclude that gastric carcinoids associated with atrophic gastritis have an excellent prognosis. On the other hand, neuroendocrine carcinomas have a very poor prognosis with fatal outcome of patients. Sporadic carcinoids have an intermediate prognosis.

REFERENCES

1. Lechago J. Avances en la patología endocrina del tracto digestivo. Patología 1994;32:255-67.

2. Roberts LJ, Bloomgarden ZT, Mamey SR, Rabin D, Gates JA. Histamine release from gastric carcinoid provocation by pentagastrin and inhibition by somatostatin. Gastroenterology 1983;54:272-275.

3. Angeles Angeles A. Hiperplasias y neoplasias endocrinas del estómago. En: Angeles Angeles A. Biopsia Endoscópica de tubo digestivo. México: Angeles Editores 2002.

4. Cappela C, Solcia E, Sobin LH, Arnold E. Endocrine Tumors of the stomach. En: Hamilton SR, Aaltonen LA. WHO Classification of Tumours: Pathology & Genetics. Tumours of the Digestive System. IARC Press. Lyon 2000:53-57.

5. Rindi G, Ombretta L, Cornaggia M, Capello C, Solcia E. Three subtypes of gastric argyrophil carcinoid and the gastric neuroendocrine carcinoma: a clinicopathologic study. Gastroenterology 1993;104:994-1006.

6. Godwin JD. Carcinoid tumors. An analysis of 2837 cases, Cancer 1975;38:560-9.

7. Sjoblom SM. Clinical presentation and prognosis of gastrointestinal carcinoid tumors. Scand J Gastroenterol 1988;23:779-787.

8. Larsson H, Carlsson E, Mattson H, et al. Plasma gastrin and gastric enterochromaffinelike cell activation and proliferation. Studies with omeprazole and ranitidine in intact and antrectomized rats. Gastroenterology 1986;90:391-399.

9. Solcia E, Bordi C, Cappella C, Creutzfeld W, Dayal D, Dayan AD, et al. Histopathological classification of nonantral gastric endocrine growths in man. Digestion 1988;41:185-200

10. MúlIer J, Kirchner T, MUller-Hermelink HK. Gastric endocrine cell hyperplasia and carcinoid tumors in atrophic gastritis type A. Am J Surg Pathol 1987;11:909-917.

11. Borch K. Atrophic gastritis and gastric carcinoid tumors. Ann Med 189;21:291-7.

12. Rindi G, Azzoni C, la Rosa S, Klersy C, Paolotti D, Rappel S, et al. ECL cell tumor and poorly differentiated endocrine carcinoma of the stomach: prognostic evaluation by pathological analysis. Gastroenterology; 1999:116:532-542.

13. Bordi C, Falchetti A, Azzoni C, D’Adda T, Canavese G, Guariglia A, et al. Aggressive forms of gastric neuroendocrine tumors in multiple endocrine neoplasia type I. Am J Surg Pathol 1997;21:1075-1082.

14. 14 Genta RM, Graham DY. Comparison of biopsy sites for the histopathologic diagnosis of Helicobacter pylori: a topographic study of H pylori density and distribution. Gastrointes Endosc 1994;40:342-345.

15. 15 Rindi G, Bordi C, Rappel S, La Rosa S, Stolte M, Solcia E. Gastric carcinoids and neuroendocrine carcinomas: pathogenesis, pathology, and behavior. World J Surg 1996;20:168-172.

16. Rappel S, Altendorf-Hofmann, Stolte M. Prognosis of gastric carcinoid tumors. Digestion 1995;56:455-462.