title: Metastatic type 1 gastric carcinoid: a real threat or just a myth?
abstract: OBJECTIVE
  To describe disease characteristics and treatment modalities in a group of rare patients with metastatic gastric carcinoid type 1 (GCA1).
  
  
  METHODS
  Information on clinical, biochemical, radiological, histopathological findings, the extent of the disease, as well as the use of different therapeutic modalities and the long-term outcome were recorded. Patients' data were assessed at presentation, and thereafter at 6 to 12 monthly intervals both clinically and biochemically, but also endoscopically and histopathologically. Patients were evaluated for the presence of specific symptoms; the presence of autoimmune disorders and the presence of other gastrointestinal malignancies in other family members were also recorded. The evaluation of response to treatment was defined using established WHO criteria.
  
  
  RESULTS
  We studied twenty consecutive patients with a mean age of 55.1 years. The mean follow-up period was 83 mo. Twelve patients had regional lymph node metastases and 8 patients had liver metastases. The primary tumor mean diameter was 20.13 ± 10.83 mm (mean ± SD). The mean Ki-67 index was 6.8% ± 11.2%. All but one patient underwent endoscopic or surgical excision of the tumor. The disease was stable in all but 3 patients who had progressive liver disease. All patients remained alive during the follow-up period.
  
  
  CONCLUSIONS
  Metastatic GCA1 carries a good overall prognosis, being related to a tumor size of ≥ 1 cm, an elevated Ki-67 index and high serum gastrin levels.
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Simona
authors.initials: S
authors.lastname: Grozinsky-Glasberg
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Strosberg
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Ulrich-Frank
authors.initials: UF
authors.lastname: Pape
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Stephan
authors.initials: S
authors.lastname: Felder
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Apostolos V
authors.initials: AV
authors.lastname: Tsolakis
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Krystallenia I
authors.initials: KI
authors.lastname: Alexandraki
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Merav
authors.initials: M
authors.lastname: Fraenkel
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Leonard
authors.initials: L
authors.lastname: Saiegh
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Petachia
authors.initials: P
authors.lastname: Reissman
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.affiliation: Simona Grozinsky-Glasberg, David J Gross, Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, 91120 Jerusalem, Israel.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gross
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000097:blood / Q000737:chemistry / Q000145:classification / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D005060:Europe; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D005755:Gastrins / Q000097:blood; D005773:Gastroscopy; D006801:Humans; D007557:Israel; D019394:Ki-67 Antigen / Q000032:analysis; D008113:Liver Neoplasms / Q000145:classification / Q000556:secondary* / Q000628:therapy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000097:blood / Q000737:chemistry / Q000145:classification / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D005755:Gastrins; D019394:Ki-67 Antigen
keywords: Chromogranin A; Gastrin; Metastatic gastric carcinoids; Somatostatin analogues; Stomach neuroendocrine tumor