title: Unusually aggressive type 1 gastric carcinoid:  a case report with a review of the literature.
abstract: Gastric carcinoids are rare tumors of the stomach. Gastric carcinoid type 1 is associated with chronic atrophic gastritis, and because of a low metastatic potential, is the most benign type. Death from metastatic disease has been reported in only three patients in a review including 724 cases. The present report refers to a 60-year-old man who was affected by type 2 diabetes mellitus and pernicious anemia and died from metastatic gastric carcinoid type 1. In 1998, a well-differentiated 1.2 cm gastric neuroendocrine tumor, immunoreactive for chromogranin A, with a Ki-67 index less than 2% and with infiltration to the submucosal layer was diagnosed and enucleated. In 2002, a new well-differentiated gastric endocrine tumor 6 mm in size with a Ki-67 of approximately 2% was detected, and endoscopic ultrasound confirmed it to be limited to the submucosal layer. The patient refused antrectomy and started long-acting somatostatin analog (lanreotide) in 2005 when the Ki-67 index was 7%, but he stopped the treatment after 4 months. In 2007, despite previous endoscopic stability, endoscopic ultrasound showed an infiltrating gastric lesion of 7 cm. At surgery, the disease appeared to be extended to the liver and to the peritoneum (well-differentiated endocrine carcinoma, Ki-67 40%) with both hepatic and massive peritoneal metastases. A regimen of somatostatin analog was soon restarted; however, the disease continued to spread, and the patient died 6 months later. Overall, despite their generally benign course, type 1 gastric carcinoids may have malignant potential, a finding that should be considered when planning the medical workup of these patients.
authors.affiliation: Gastrointestinal Unit II, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico Milano, Milan, Italy. matildepia@libero.it
authors.forename: Matilde Pia
authors.initials: MP
authors.lastname: Spampatti
authors.forename: Sara
authors.initials: S
authors.lastname: Massironi
authors.forename: Roberta Elisa
authors.initials: RE
authors.lastname: Rossi
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Valentina
authors.initials: V
authors.lastname: Sciola
authors.forename: Clorinda
authors.initials: C
authors.lastname: Ciafardini
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrero
authors.forename: Lucia
authors.initials: L
authors.lastname: Lodi
authors.forename: Maddalena
authors.initials: M
authors.lastname: Peracchi
mesh_terms: D002276:Carcinoid Tumor / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D018450:Disease Progression; D019160:Endosonography; D017809:Fatal Outcome; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology