Succesful treatment of type-1 gastric carsinoid by endoscopic polypectomy and argon plasma coagulation

Neuroendocrine tumors (NETs) are originating from neuroendocrine cells. Discrimination of the subtypes of gastric NETs is important for their management (1). Sug- gested management of these tumors have been controver- sial and been containing different therapeutic strate- gies (2). We herein report a rare case of type 1 gastric NET which was treated with endoscopic polypectomy and argon plasma coagulation (APC). A-44-year-old woman was admitted to our hospital due to epigastric pain. On admission, laboratory tests showed low hemoglobin, mean corpuscular volume (MCV) and B12 levels. The patient underwent to esopha- gogastroduodenoscopy (EGD) because of iron and B12 deficiency. EGD examination revealed multiple intralu- minal polypoid lesions in gastric corpus (there were 7 small nodular lesions in diameter < 1 cm and one irregu- lar-shaped polyp in diameter with 18 mm) (Fig. 1A-B). Biopsy samples were taken from the lesions and also mu- cosal areas of antrum and corpus. Biopsy samples were examined after histochemical staining with Chromo- granin A, synaptophysin and proliferative activity (ki-67 index). They were positive by Chromogranin A (CgA) and synaptophysin. The surrounding mucosa indicated atrophic gastritis and hyperplasia of enterochromaffin- like (ECL) cells. Fasting serum gastrin value and serum antibody levels against gastric parietal cells were very high with 908pg/ml (normal levels: 13-115pg/ml), 94 U/ml (normal values < 10 U/ml), respectively. A di- agnosis of autoimmune atrophic gastritis, type 1 gastric carcinoid was made.