1. Microcarcinoidosis of the Stomach
순천향대학교병원
진소영

2. Case History 65/M C.C. : Recurrent gastric polyps D : 1 year PHx ROS
EMR : Gastric carcinoids, 1 month ago
DM for 10 years
ROS
Diarrhea(-), Flushing (-)

3. GFS
Previous EMR defects and multiple tiny polyps throughout the body

4. Lab. Findings Hb/Hct 13.5/39.6 WBC/Platelet 7,500/279,000
Glucose (70-110)
SGOT/SGPT (0-37)/45(0-41)
Amylase/lipase (0-100)/15.3
CEA/CA /0.83
24hrs urine HIAA 2.7mg/day(1.6-6)
Serotonin ng/mL( )

5. High body, LC : EMR Mid body, GC : EMR Other sites : Hot biopsy x 3
외부병원 조직검사
High body, LC : EMR
Mid body, GC : EMR
Other sites : Hot biopsy x 3

6. High Body

7. Mid body

8. Hot Biopsy

9. 제1차 EISD Upper Body

10. Residual Carcinoid in M & SM

11. Microcarcinoid

12. Micronodular Hyperplasia

13. Histochemistry
Grimelius

14. 제2차 EISD Midbody

15. Residual Carcinoid in M

16. Residual Carcinoid in M & SM

17. Adenomatoid Hyperplasia

18. Micronodular Hyperplasia

19. Upper Body Midbody Residual carcinoid
Micronodular hyperplasia, diffuse, intramucosal
Adenomatoid Hyperplasia to Microcarcinoid, µm

20. Hyperplastic Changes of Gastric Endocrine Cells
Simple or Diffuse hyperplasia
> x2 of control
<5 cells aggregates
ZES or hypergastrinemia
Linear hyperplasia
Linear 5+ cells lying inside of BM of gastric gland
ZES or pernicious anemia
Micronodular hyperplasia
Clusters of 5+ cells
Mean : 50 µm in diameter, less than <150 µm
One cluster/mm of mucosa
Autoimmune gastritis of the corpus-fundus (type A CAG)
Adenomatoid hyperplasia
Collection of 5+ micronodules with intact BM

21. Dysplastic Growths of Gastric Endocrine Cells
µm in diameter
Escape endoscopic observation
Always intramucosal
Histologic patterns
Enlarged micronodules
Adenomatous micronodules : >5 micronodules, intact BM
Fused micronodules : BM loss
Microinfiltrative lesions
Nodules with newly formed stroma

22. Argyrophil ECL-Cell Carcinoids
3 Clinical Subtypes
Type 1 : diffuse chronic atrophic gastritis of autoimmune or A type (A-CAG)
Type 2 : hypertrophic gastropathy with MEN type 1-ZES
Type 3 : Sporadic, without specific gastric pathology

23. Clinical Behaviors of Sporadic ECL Tumors
Rarely multiple
No hypergastrinemia
No gastrin-dependent ECL-cell hyperplasia
High risk for low grade malignancy
Frequent deep wall invasion
Definite metastatic potential

24. Criteria of Malignant Potential
Tumor size > 1cm
Wall invasion : beyond the SM
Structural atypia : solid, central necrosis
Cellular atypia
>2/10HPF
Ki-67 (+) cells : >50/10HPF or >2%
Angioinvasion, Perineural invasion
Loss of granular markers
P53 overexpression

25. Management of Microcarcinoidosis
Total gastrectomy ?
Regular follow up endoscopy + Polypectomy of visible polyps ?