title: Multiple gastric carcinoids associated with parietal cell hyperplasia: intraoperative detection with a radiolabeled somatostatin analog.
abstract: We describe a 30-year-old man in whom upper endoscopy revealed multiple gastric carcinoids. The peripheral blood gastrin level was 2400 ng/ml (normal range, <200 ng/ml). Mucosal biopsy of the gastric body and fundus showed no atrophy; typical type A chronic atrophic gastritis was thus unlikely. Neither abdominal computed tomography nor selective angiography showed any evidence of tumor in the pancreas or at its periphery. However, the possibility of microgastrinoma could not be ruled out. We performed radioguided surgery with a somatostatin analog, diethylenetriamine pentaacetic acid-D-Phe1-octreotide labeled with (111)In (Octreo Scan). The location of the carcinoids was confirmed. Gastrinoma was ruled out. Total gastrectomy was performed, and the gastrin level decreased to the normal range. Macroscopically, 20 carcinoid tumors, measuring 30 mm in maximum diameter, were confirmed. Microscopic examination showed large numbers of endocrine cell micronests. Hyperplasia of parietal cells was observed, suggesting early-stage type A chronic atrophic gastritis. The antrum contained increased numbers of gastrin-positive cells, which probably caused the preoperative hypergastrinemia.
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hosoya
authors.forename: Kiichi
authors.initials: K
authors.lastname: Satoh
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Hironaka
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nokubi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kurashina
authors.forename: Chiaki
authors.initials: C
authors.lastname: Shibayama
authors.forename: Hideharu
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Hideo
authors.initials: H
authors.lastname: Nagai
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
mesh_terms: D000328:Adult; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005743:Gastrectomy / Q000379:methods; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D006965:Hyperplasia; D008297:Male; D010295:Parietal Cells, Gastric / Q000473:pathology*; D019275:Radiopharmaceuticals; D013004:Somatostatin / Q000031:analogs & derivatives*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods
chemical_list: D005755:Gastrins; D019275:Radiopharmaceuticals; D013004:Somatostatin; C081788:pentetreotide