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Minute type I gastric carcinoid with regional lymph node metastasis
Renato Micelli Lupinacci1, André Roncon Dias, Evandro Sobroza Mello
1Hospital do Servidor Estadual, Sao Paulo, Brazil.
International Journal of Surgical Pathology
|August 28, 2012
Summary
Small gastric carcinoids (Type I) can metastasize, challenging prior beliefs. This case highlights the need for better assessment of malignant potential in these neuroendocrine tumors.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Type I gastric carcinoids are typically indolent and rarely metastasize.
- Lymph node metastasis was previously associated with large (≥10 mm) and invasive lesions.
Observation:
- A diminutive (8 mm) gastric carcinoid, confined to the superficial submucosa (sm1), was identified.
- The lesion showed no angiovascular invasion but had a high Ki-67 index (7%).
Findings:
- A perigastric lymph node was involved, indicating metastasis.
- This contradicts the assumption that small, superficial Type I gastric carcinoids do not metastasize.
Implications:
- This case necessitates revised parameters for evaluating the malignant potential of gastric carcinoids.
- It supports the 2010 World Health Organization classification for gastrointestinal neuroendocrine tumors.
