Giant type III well-differentiated neuroendocrine tumor of the stomach: A case report.
BACKGROUND
We describe a case of a large type III neuroendocrine tumor of the stomach. Management and current literature are reviewed.


METHODS
A 37year old female presented with upper gastrointestinal bleed and epigastric pain. Further workup demonstrated a large ulcerated gastric mass near the GE junction. Computer tomography scan and endoscopic ultrasound showed a 10cm mass with no evidence of distant disease. Fine needle aspiration pathology was consistent with a well differentiated neuroendocrine tumor (Ki67 index<2%), with elevated levels of chromogranin A and serotonin levels but normal gastrin. The patient underwent an uneventful total gastrectomy. Final pathology analysis reported a higher KI67 index (7.54%) and a final pathology of grade 2 type III, T3 N3, neuroendocrine tumor of the stomach. The chromogranin levels normalized and no recurrent disease has been detected in one year follow up.


CONCLUSIONS
Gastric neuroendocrine tumors are extremely rare, accounting for 4% of all neuroendocrine tumors of the body and 1% of all neoplasms of the stomach. Based on histomorphologic characteristics and pathogenesis, gastric neuroendocrine tumors are classified into four types with differing prognosis and behavior. Current literature describes type 3 gastric neuroendocrine tumors as larger than 2cm. However, there is no precedent in the literature for a tumor of this size.


CONCLUSIONS
The incidence of gastric neuroendocrine tumors has been increasing during the last decade, underscoring the need to improve our understanding of their biology and behavior. When identified histologically, patient outcomes depend on appropriate determination of tumor biology and subsequent choice of treatment.
Department of General Surgery, New York Presbyterian Queens/Weill Cornell Medical College, 5645 Main Street, suite 300, Flushing, NY 11355, USA. Electronic address: omarbellorin@gmail.com.
Omar
O
Bellorin
Department of General Surgery, New York Presbyterian Queens/Weill Cornell Medical College, 5645 Main Street, suite 300, Flushing, NY 11355, USA. Electronic address: ars9047@nyp.org.
Ariel
A
Shuchleib
Department of General Surgery, New York Presbyterian Queens/Weill Cornell Medical College, 5645 Main Street, suite 300, Flushing, NY 11355, USA. Electronic address: alh9096@nyp.org.
Alexandra E
AE
Halevi
Department of Pathology, New York Presbyterian Queens/Weill Cornell Medical College, 5645 Main Street, Flushing, NY 11355, USA. Electronic address: saa9072@nyp.org.
Sergei
S
Aksenov
Department of General Surgery, New York Presbyterian Queens/Weill Cornell Medical College, 5645 Main Street, suite 300, Flushing, NY 11355, USA. Electronic address: pfs9003@med.cornell.edu.
Pierre F
PF
Saldinger
Case report; Gastric neuroendocrine tumor