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Abstract : |
We describe an unusual presentation of a highly malignant type III gastric carcinoid tumor, an incidental finding in a 60 years old female admitted for gallstone disease. The case is presented in a historical fashion, with every stage diagnosis described and reasoned. A well confined liver tumor was falsely assumed as a liver haemangioma, while the primary gastric tumor was revealed only after the passage of a naso-gastric tube which triggered an upper gastro-intestinal bleeding episode. Diagnostic endoscopy revealed a small tumor, but histological examination on biopsy specimen suggested a poorly differentiated carcinoma. Standard total gastrectomy with D2 lymphadenectomy was performed, with good tumor clearance but local metastases were confirmed in adjacent lymphnodes. Final pathology proved a type III highly malignant carcinoid tumor, with mixed cellularity. Follow-up 3 months later showed an explosive development of the liver tumors demonstrating not only the metastatic origin but also the aggressiveness the sporadic gastric carcinoid tumor. Although prognosis is very poor we believe that the errors that marked such a difficult diagnosis could bring back in attention the rare condition of a sporadic gastric carcinoid which can represent up to 30% of all carcinoid tumors, but only 1% of all gastric tumors. Unusual aspects of liver metastases should prompt biopsy and histological confirmation. , |
