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Clinical management of gastric carcinoid tumors.

Artikel i vetenskaplig tidskrift
Författare Håkan Ahlman
Lars Kölby
Lars Lundell
Lars Olbe
Bo Wängberg
G Granérus
L Grimelius
Ola Nilsson
Publicerad i Digestion
Volym 55 Suppl 3
Sidor 77-85
ISSN 0012-2823
Publiceringsår 1994
Publicerad vid Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi
Sidor 77-85
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Carcinoid Tumor, epidemiology, surgery, Combined Modality Therapy, Female, Gastrinoma, epidemiology, surgery, Humans, Lymphatic Metastasis, Male, Middle Aged, Multiple Endocrine Neoplasia Type 1, epidemiology, surgery, Retrospective Studies, Stomach Neoplasms, epidemiology, surgery, Zollinger-Ellison Syndrome, epidemiology, surgery
Ämneskategorier Cancer och onkologi, Kirurgi

Sammanfattning

Four types of gastric carcinoids have been identified: (1) multiple small body-fundus carcinoids associated with chronic atrophic gastritis type A (A-CAG); (2) sporadic solitary lesions without specific pathogenetic background (non-A-CAG); (3) carcinoidosis associated with Zollinger-Ellison/MEN 1 syndrome, and (4) rare tumors, e.g. gastrin cell tumors, neuroendocrine carcinomas and mixed endocrine-exocrine tumors. In a retrospective study of 15 patients with gastric carcinoids (11 A-CAG, 3 non-A-CAG and 1 gastrin cell tumor) over a 10-year period, the histopathological and clinical features were assessed. The A-CAG-type carcinoids were clinically silent with lymph node metastases in 2/11 cases but no hepatic metastases. The non-A-CAG-type carcinoids were malignant with disseminated disease, hormonal symptoms and increased urinary excretion of the main histamine metabolite, MeImAA. Five patients with A-CAG tumors were subjected to antrectomy to remove hypergastrinemia, which is thought to be of pathogenetic importance for these tumors. During the observation period (1.5-8 years) 1 patient developed recurrent tumors, while the other 4 showed persistent argyrophil cell hyperplasia. A prospective treatment protocol of these tumors is suggested with endoscopic removal of less numerous, small lesions as first-step therapy, followed by antrectomy at recurrence. Larger lesions should be excised in combination with antrectomy. Gastrectomy is reserved for the rare cases of invasive tumors with lymph node metastases. As evident from the outcome of patients with non-A-CAG tumors radical surgery should be performed whenever practicable.

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