The validity of current guidelines regarding surgical management of patients with gastric neuroendocrine neoplasms type 1: a report of a series of seven patients.

OBJECTIVE: Gastric neuroendocrine neoplasms Type 1 (GEN type 1) are mostly localized indolent tumors, with only a minority developing lymph node or distant metastasis. Although they are usually managed conservatively, large, invasive, recurrent and grade 2 lesions may require surgical treatment. The aim of this case series is to evaluate the validity of current guidelines regarding surgical management of patients with GEN type 1. CASES: Seven patients (5 female) with GEN type 1 underwent peri-gastric lymphadenectomy when at least one of the following criteria employed in previous guidelines was present: (i) multiple recurrent lesions, (ii) lesions with positive margins following endoscopic resection, (iii) lesions with malignant potential (deep gastric parietal wall invasion, lymph node enlargement, Ki67 proliferative index >2%), or (iv) presence of metastatic disease. Four patients met one and three two of the previously defined criteria; fifteen to thirty-six peri-gastric lymph nodes were resected. Following surgery there was no alteration in tumor staging status compared to pre-surgical staging. During a median follow-up of 34 months, all patients remain without any evidence of disease recurrence. CONCLUSION: Peri-gastric lymphadenectomy did not prove to be necessary for localized GEN type 1, neither for staging nor for therapeutical reasons. Further parameters need to be evaluated to identify the small subset of patients that will develop more aggressive disease.

Primary hyperparathyroidism in patients with gastric carcinoid tumors type 1: an unusual coexistence.

OBJECTIVE: Although a number of familiar syndromes are associated with primary hyperparathyroidism (PHP), there is no information regarding the prevalence of PHP in other sporadic neuroendocrine diseases. The aim of this study is to investigate the prevalence of PHP in our group of patients with gastric carcinoid (GC) type 1 tumors. METHODS: Twenty-six patients with biopsy-proven GC type 1 tumors were retrospectively studied. The diagnosis of PHP was suspected following elevated or high-normal serum calcium levels and elevated or inappropriate normal parathyroid hormone levels. Further tests for the localization of the hyperfunctioning parathyroid glands included neck ultrasound, (99m)Tc-SESTAMIBI scanning, and cervical or upper mediastinal MR imaging studies. Four control groups were also studied: two age- and sex-matched groups of individuals with (n = 49) and without (n = 34) thyroid autoimmunity and normal endoscopy of the stomach, a third group with nongastric neuroendocrine tumors (n = 68), and a fourth group with atrophic gastritis and hypergastrinemia, without gastric endocrine tumors (n = 30). RESULTS: PHP was diagnosed in 4 (15.38%) patients with GC type 1 tumors compared to none of the 4 control groups. Three of the 4 patients with PHP were operated and proved to have a parathyroid adenoma. No statistically significant differences were observed between patients with or without PHP in mean gastrin and chromogranin A levels, number of lesions, ki-67 labeling index expression, and maximum GC type 1 tumor diameter. CONCLUSION: PHP seems to be relatively common, approximately 15% in the present cohort, in patients with GC type 1 tumors. PHP should be actively looked for in such patients and treated accordingly.