Multiple gastric carcinoids associated with hypergastrinemia. A review of five cases with clinicopathological analysis and surgical strategies.

Previously, total gastrectomy was regarded as the treatment for multiple gastric carcinoids because of the unknown biological characteristics of this disease. Recent studies, however, have revealed that type 1 gastric carcinoids have a low potential for malignancy. In this study, five patients with hypergastrinemia and multiple gastric carcinoids, who underwent gastrectomy with regional node dissection, were analyzed. On serum chemistry examinations, the serum gastrin level was found to be high (515.5-over 3000 pg/ml) in all patients pre-operatively, but returned to a normal range (40-50 pg/ml) in all three cases examined post-operatively. Histopathological examination of our five cases revealed multiple gastric tumors, i.e. three to five tumors in Cases 1-4 and numerous tumors in Case 5. The multiple tumors were histologically carcinoid tumors up to 15 mm in size, limited to the submucosa, and no lymph node metastasis was identified in any of the cases. The patients were followed-up at outpatient clinics with no additional adjuvant therapy, and there was no evidence of recurrence during follow-up. Recently, minor invasive surgery such as endoscopic mucosal resection or laparoscopic antrectomy has been performed to treat type 1 gastric carcinoids. Our data provide important insights into understanding the biological behavior of multiple gastric carcinoids.