Naveen S, MBBS1, deepak HL, MBBS1, Sreekanth Avula, MD2, Rahul Rauniyar, MBBS2, Rohit Rauniyar, MBBS3, Amarendra S, MBBS1, Gopinath KS, MBBS1 1HCG Cancer Hospital, Bangalore, Karnataka, India; 2Wright Center for GME, Scranton, PA; 3McLaren Flint, Flint, MI
Introduction: Gastric Neuroendocrine tumors are a rare entity with incidence of 1 in one million. They are derived from Enterochromaffin- like cells of gastric mucosa. We here present a rare care of Gastric Neuroendocrine tumor with periampullary carcinoma.
Case Description/Methods: Patient is 42 yrs old male with no significant past medical history presented with the complaints of jaundice and intermittent fever . Patient was evaluated with labs and imaging. Patient Liver enzymes were elevated with GGT (Gamma-glutamyl transpeptidase) : 219 U/L ,SGPT(ALT) : 49 U/L , SGOT(AST) : 86 U/L, Alkaline Phosphatase : 619 U/L , Total Bilirubin : 2.2 mg/dL. CT abdomen and pelvis showed dilated common bile duct of 1.2 cm. He underwent Upper GI endoscopy and ERCP. During endoscopy patient was found to have multiple polyps in the stomach. He was also found to have mass in the peri-ampullary region causing biliary obstruction. ERCP and CBD stenting was done and biopsy from the peri-ampullary mass and gastric polyps were taken. Histopathology of the biopsy revealed Neuroendocrine tumor of the gastric polyps and Peri-ampullary adenocarcinoma. Patient later underwent elective Total gastrectomy and Whipple’s surgery. Histopathology of the specimen showed Well differentiated Neuroendocrine tumors of stomach with pathological stating of pT2No and Moderately differentiated Adenocarcinoma of Ampulla with free margins and free regional lymph nodes with pathological staging of pT3aNo. Immunohistochemistry was done which was positive for Chromogranin A and less than 2% proliferative index Ki 67.
Discussion: Gastric Neuroendocrine tumors ( GNET) are rare tumors arising for enterochromaffin like cells. GNETs comprises of groups of different tumors of varying morphologies, histopathology, and symptomatology. They are widely classified into four main subclasses and hence tumor features, prognosis, managements depend on classification. Type 1 is the most common variety and has less malignant potential. Treatment of GNETs depend on clinical type, extent of disease, pathological grading , differentiation of tumor and presents of poor prognostic factors. Adequate imaging, histopathology and immunostaining is necessary for accurate classification and diagnosis. Incidence of presence of NET’s along with other primary tumors is exceedingly rare and often missed. Hence patients diagnosed with NET’s would need more extensive work up to look for other primary or secondary tumors which is seen in our case report.
Figure: Endoscopic images showing multiple polyps in stomach along with resected gross specimen
Disclosures: Naveen S indicated no relevant financial relationships. deepak HL indicated no relevant financial relationships. Sreekanth Avula indicated no relevant financial relationships. Rahul Rauniyar indicated no relevant financial relationships. Rohit Rauniyar indicated no relevant financial relationships. Amarendra S indicated no relevant financial relationships. Gopinath KS indicated no relevant financial relationships.
Naveen S, MBBS1, deepak HL, MBBS1, Sreekanth Avula, MD2, Rahul Rauniyar, MBBS2, Rohit Rauniyar, MBBS3, Amarendra S, MBBS1, Gopinath KS, MBBS1. P3108 - A Rare Case of Gastric Neuroendocrine Tumor Along With Periampullary Adenocarcinoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.