Gastric carcinoids and their precursor lesions: a histologic and immunohistochemical study of 23 cases

Carcinoids are tumors usually associated with the gastrointestinal tract, although similar lesions may occur in the bronchial tubes of the lungs as well. Carcinoids were given their name at a time when it was believed that they could not metastasize, but now it is recognized that these tumors are, in some cases, capable of metastatic spread. Older pathology books state that carcinoids of the stomach comprise no more than five percent of all carcinoids of the gastrointestinal tract. However, the widespread use of endoscopy has led to the recognition that gastric carcinoids are, in fact, far more common than previously suspected and may actually comprise one-third of all gastrointestinal carcinoids. Several conditions confer high risk for the development of gastric carcinoids. Among these is pernicious anemia; up to nine percent of all pernicious anemia patients may have gastric carcinoids. These tumors are also likely in patients taking inhibitors of gastric secretion for Zollinger-Ellison syndrome, which is associated with secreting pancreatic tumors. Hypergastrinemic chronic atrophic gastritis type A is also associated with the development of gastric carcinoids. There is evidence that in all these conditions, the trophic effect of excess gastrin contributes to the development and growth of the carcinoid. In such cases, surgical removal of the antrum of the stomach, where the gastrin-secreting cells are located, may result in the regression of the carcinoids, and be preferable to removal of most, or all, of the stomach. A histopathological study of 23 gastric carcinoids was conducted, and it was found that in 19 cases the syndrome was associated with hypergastrinemic chronic atrophic gastritis type A. Such patients would be good candidates for the less aggressive surgical approach of antral resection. The remaining four carcinoids, however, showed histological signs of being more aggressive, and signs of hypertrophy of gastrin-secreting cells were not found in these specimens. These four carcinoids, therefore, would not have been expected to respond to antrectomy, and aggressive surgical treatment would be advisable. (Consumer Summary produced by Reliance Medical Information, Inc.)