Endocrine Abstracts

Gastric carcinoids secondary to autoimmune atrophic gastritis (GC type 1) are usually well differentiated neoplasia, with an indolent course and an excellent overall prognosis. However, a subset of these tumors (<5%) may develop advanced disease, with lymph node and/or hepatic metastasis. The pathogenesis of these carcinoids is related to chronic trophic stimuli to enterochromaffin-like (ECL) cells due to chronic hypergastrinemia. Treatments directed to remove the source of hypergastrinemia (such as antrectomy and SSAs) have been used with good results in localized tumors. These approaches had been used in localized disease, while its effectiveness had never been demonstrated in metastatic cases. In this report, we describe the case of a woman with type 1 gastric carcinoid with liver metastasis documented by abdominal CT and ⁶⁸Ga-PET DOTATOC. The patient underwent total gastrectomy with lymph node dissection; during surgery an hepatic US was performed, showing seven subcentimeter metastases. Histological examination revealed a neuroendocrine neoplasm G2 (WHO 2010) of 30 mm, Ki67 20%, 15 mitoses/10 HPF; chronic gastritis and micronodular hyperplasia of endocrine cells was associated. During the early months of follow up a gradual reduction in size of liver metastases, until the complete disappearance of them was observed. This is to our knowledge the first case ever described in literature of complete remission of liver metastatic type 1 GC after removal of the source of excessive gastrin, showing a possible preservation of responsiveness of metastases to gastrinemic stimuli. This could lead to a possible change in therapeutic approach in these neoplasm.