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Gastric Neuroendocrine Tumor and Duodenal Gastrinoma With Chronic Autoimmune Atrophic Gastritis

Chen, William C., MD*; Warner, Richard R. P., MD; Harpaz, Noam, MD, PhD; Zhu, Hongfa, MD, PhD; Roayaie, Sasan, MD§; Kim, Michelle Kang, MD, PhD

doi: 10.1097/MPA.0000000000001204
Case Reports

Our group observed the first case of synchronous gastric neuroendocrine tumor (NET) and duodenal gastrinoma with autoimmune chronic atrophic gastritis (CAG), in the absence of Helicobacter pylori infection. Demographic, clinical, endoscopic, and pathologic data were abstracted from the electronic medical record at Mount Sinai Hospital from 2013 to 2015. The patient's anonymity was carefully protected, and informed consent was obtained for publication of protected health information. A 53-year-old woman with hypertension presented to Mount Sinai Hospital in June 2013 for a second opinion for management of gastric and duodenal NETs. After evaluation by gastroenterology and surgery, repeat upper endoscopy with ultrasound and fine-needle aspiration revealed multiple diminutive type I gastric NETs and 2 duodenal NETs, against a background of autoimmune CAG, with biopsy pathology negative for H. pylori. She subsequently underwent a transduodenal resection of the duodenal NETs, confirming low-grade, gastrin-positive, stage T2 duodenal NET. On routine follow-up over the next 2 years, clinical, radiographic, and endoscopic surveillance revealed no recurrent or metastatic gastric or duodenal disease. This first report of synchronous duodenal gastrinoma and gastric NET in the setting of autoimmune CAG can broaden our understanding of gastric NET pathophysiology.

From the *Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; and

Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York;

Division of Gastrointestinal Pathology, Department of Pathology, Icahn School of Medicine at Mount Sinai, New York; and

§Department of Surgery, White Plains Hospital, White Plains, NY.

Received for publication May 11, 2018; accepted October 23, 2018.

Address correspondence to: Michelle Kang Kim, MD, PhD, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029 (e-mail: michelle.kim@mssm.edu).

The authors declare no conflict of interest.

Acquisition of data: W.C.C., N.H., H.Z., S.R., M.K.K. Analysis and interpretation of data: W.C.C., M.K.K. Drafting of the manuscript: W.C.C., M.K.K. Critical revision of the manuscript: W.C.C., R.R.P.W., N.H., H.Z., S.R., M.K.K.

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