Among the gastric submucosal tumors, neuroendocrine tumors are a special entity, which also require examination of independent gastric mucosal biopsies for classification.
Accordingly, there are three different categories, type I is by far the most frequent type; here lesions are mostly multiple and small.
Type
gastric pathology/assoc.
malignant potential
Type I
atrophic body gastritis
very low, rarely low-grade malignant
Type II
MEN-I
up to 30%
Type III
none (sporadic)
frequent (50-100%)
Their direct appearance however cannot be correlated to any of these types.
Figure 1a
Figure 1b
Figure 2a
Figure 2b
Often they have a reddish and/or villous-like suerface and may occasionally almost look like an adenoma (Fig 1), but can also have a fleshy or glassy appearance (Fig 2a) with visible redding or vascular structures (Fig 2b),
Figure 3a
Figure 3b
Figure 4
or have superficial fibrinous erosions (Fig 3, here also the vascular network is well visible), which can give rise to spontaneous bleeding (Fig 4).
Figure 5
Figure 6
Figure 7
Some of them look like „normal“ submucosal tumors (Fig 5 with slight central depression and also vascular network), other look like extended superficial adenomas (Fig 6) or like aberrant pancreas (Fig 7 even if not located in the antrum).
Figure 8
It is noteworthy that type I lesions are often multiple (Fig 8).
Selected Reading
Sato Y, Hashimoto S, Mizuno K, Takeuchi M, Terai S. Management of gastric and duodenal neuroendocrine tumors. World J Gastroenterol. 2016 Aug 14;22(30):6817-28.
La Rosa S, Vanoli A. Republished: gastric neuroendocrine neoplasms and related precursor lesions. Postgrad Med J. 2015 Mar;91(1073):163-73
Written by:
Stefan Groth and Thomas Rösch, Hamburg
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