2020 Volume 62 Issue 1 Pages 39-45
A 51-year-old male exhibited multiple submucosal tumors (SMT) all over the gastric corpus on esophagogastroduodenoscopy (EGD). Pathologic examination of biopsy specimens of the SMT led to the diagnosis of neuroendocrine tumor (NET), grade 2 (G2), according to the 2010 World Health Organization (WHO) grading system. Moreover, EGD revealed extensive atrophic mucosa over the gastric corpus, and a blood test revealed hypergastrinemia and positivity for anti-parietal cell antibody. Dynamic computed tomography and positron-emission tomography/computed tomography revealed no abnormal findings. Thus, the patient was diagnosed with multiple gastric NETs (type 1, Rindi classification; the number of NETs, 8), accompanied by autoimmune gastritis. We were indecisive regarding whether to perform endoscopic treatment or surgical treatment. We discussed this with the patient, and he finally selected and underwent total gastrectomy with lymphadenectomy. The postoperative pathological examination revealed 14 NETs (maximum diameter, 7 mm) in the gastric corpus; most were NET G1, and small parts were NET G2. Although total gastrectomy was the chosen treatment for this case, reports of multiple gastric NETs (type 1) for which less invasive treatments (e.g., endoscopic resection or limited operation) were selected have recently been increasing. Here, we report our experience of a patient with multiple gastric NETs (type 1), along with a literature review and discussion primarily regarding the selection of treatment for this disease.
