A 57-year-old female patient was admitted for evaluation of multiple focal liver lesions diagnosed with abdominal ultrasound and CT. Her medical history included severe rheumatoid arthritis and pernicious anaemia treated with vitamin B12. Gastroscopic examination revealed numerous small polypoid lesions within the stomach, and histology of tissue samples obtained by biopsy showed carcinoid associated with atrophic gastritis. Although the patient had no symptoms of carcinoid syndrome, 24 hour urinary excretion of 5-hydroxyindole acetic acid (5-HIAA) was elevated and serum chromogranin A (CgA) was three times higher than the upper limit of the reference range. Octreoscan showed focal radionuclide accumulation corresponding to the stomach and the liver. Because of the severe rheumatoid arthritis surgical therapy was not considered. After 7 months of octreotide LAR treatment abdominal ultrasound and CT showed a complete remission of liver lesions and repeat octreoscan failed to show pathologic radionuclide accumulation. Repeat gastroscopy was also negative and biopsy revealed chronic atrophic gastritis and a scattered pattern of chromogranin-positive cell-nests. In accordance with regression of the carcinoid tumor, urinary 5-HIAA excretion and serum CgA levels returned to normal.
Although somatostatin analogues have been shown to induce regression of gastric carcinoid tumors associated with pernicious anemia-related hypergastrinemia, a complete regression of liver metastases after somatostatin-analogue treatment has rarely been documented. In addition, our case demonstrates not only the efficacy of octreotide for treatment of metastatic gastric carcinoid but also the importance of octreotide treatment in cases without carcinoid syndrome.