title: Development of a gastric carcinoid tumor following allogeneic hematopoietic stem cell transplantation for early T-cell precursor acute lymphoblastic leukemia.
abstract: Gastric carcinoid tumor is rarely diagnosed in children. We report a case of gastric carcinoid tumor that occurred after allogeneic HSCT. A 13-year-old girl with ETP acute lymphoblastic leukemia underwent allogeneic HSCT from a 7/8 HLA-matched unrelated donor. She presented with rashes, abdominal pain, and diarrhea, which were suggestive of GVHD, 7 months after HSCT. Immunosuppressive agents failed to resolve these symptoms well. After a series of evaluations, carcinoid syndrome caused by a gastric carcinoid tumor was diagnosed. The tumor was located in the antral region and resulted in partial gastric outlet obstruction. She received subtotal gastrectomy with regional lymph node dissection. However, she had a flare-up of GVHD 1 month after surgery, and immunosuppressive therapy was intensified accordingly. Although her GVHD was getting better, she developed respiratory syncytial viral pneumonia with rapid progression to respiratory failure. She died of multiple organ failure 2 months postoperatively. This is the first pediatric case of a gastric carcinoid tumor following allogeneic HSCT. Our case also highlights the necessity for pediatric transplant physicians to be aware of carcinoid syndrome caused by this rare tumor in the setting of GVHD with poor response to immunosuppressive agents.
authors.affiliation: Division of Pediatric Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Tsung-Yen
authors.initials: TY
authors.lastname: Chang
authors.affiliation: Division of Pediatric Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chao-Jan
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Division of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Shih-Yen
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Division of Pediatric Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Lee-Yung
authors.initials: LY
authors.lastname: Shih
authors.affiliation: Division of Pediatric Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Shih-Hsiang
authors.initials: SH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000175:diagnosis; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008303:Malignant Carcinoid Syndrome / Q000150:complications / Q000175:diagnosis*; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis*; D014184:Transplantation, Homologous
keywords: children; gastric carcinoid tumors; graft-versus-host disease; hematopoietic stem cell transplantation