Carcinoid Neoplasms

ABSTRACT Pearls and PitfallsGastric CarcinoidsGastrin-dependent gastric carcinoids and gastric endocrine cell hyperplasia occur in 1% of patients with atrophic gastritis, and in MEN1 patients with Zollinger-Ellison syndrome, with increased gastric acid, and without mucosal atrophy.Correct diagnosis requires multiple gastric mucosal biopsies:If biopsies show atrophic gastritis, the carcinoid is type 1; endoscopic excision and surveillance is adequate because risk for metastases is minimal.If there is no atrophic gastritis and the patient has MEN1, the carcinoid is type 2, and usually single, larger, invasive, and requires resection.In the absence of atrophic gastritis and MEN1, the lesion is type 3, sporadic gastric carcinoid prognosis is poorer, and aggressive resection is warranted.Midgut CarcinoidsThe small ileal tumor and large mesenteric metastases encircled by fibrosis should raise suspicion of a midgut carcinoid.Even with grossly radical excision, liver metastases may o ...