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Neuroendocrine Gastric Tumors

Stefan Groth and Thomas Rösch, Hamburg

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.

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),

 

or have superficial fibrinous erosions (Fig 3, here also the vascular network is well visible), which can give rise to spontaneous bleeding (Fig 4).

 

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).

 

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

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