Endoscopy 2008; 40: E12
DOI: 10.1055/s-2007-995393
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Microcarcinoid tumor diagnosed with high-resolution magnification endoscopy and narrow band imaging

R.  Singh1 , K.  Yao1 , G.  Anagnostopoulos1 , P.  Kaye1 , K.  Ragunath1
  • 1Wolfson Digestive Diseases Centre, University Hospital, Queen’s Medical Centre, Nottingham, UK
Weitere Informationen

R. Singh, MRCP

Wolfson Digestive Diseases Centre

University Hospital

Queen’s Medical Centre

Nottingham

NG7 2UH

United Kingdom

Fax: +44-115-9249924

eMail: rajvindersingh2003@yahoo.com

Publikationsverlauf

Publikationsdatum:
18. Februar 2008 (online)

Inhaltsübersicht

A 63-year-old patient presented with persistent dyspepsia. Endoscopy revealed an 8-mm nodule on the anterior wall of the greater curvature in the proximal part of the body of the stomach. Histological analysis demonstrated a well-differentiated tumor showing positive immunostaining with chromogranin with a background mucosa showing features of atrophic gastritis. Gastric pH and fasting serum gastrin levels were elevated. A diagnosis of a type I carcinoid tumor was made. The patient then underwent endoscopic mucosal resection with complete resection of the lesion. Follow-up endoscopy 3 months later showed a scar at the previous resection site. However, a diminutive, flat, reddened lesion measuring less than 3 mm with the appearance of an erosion was detected at a separate site on the posterior wall of the greater curvature ([Fig. 1] a). Narrow-band imaging demonstrated that, at the center of the lesion, the pit structure had disappeared ([Fig. 1] b). Magnification endoscopy with white light revealed that the subepithelial capillary network was well preserved, but underneath the epithelium, a faint yellowish hue could be seen ([Fig. 1] c). These findings were distinctly different from those of a gastric erosion or a minute gastric carcinoma. In an erosion dilated subepithelial capillaries are seen, and in the center of the erosion whitish inflammatory exudates will be visualized [1]. On the other hand, a flat early carcinoma would exhibit proliferation of the subepithelial capillaries, which would be irregular in both caliber and tortuosity [2]. Taking into consideration the patient’s previous history, we suspected the lesion could have originated from an endocrine nest/microcarcinoid [3] which had grown just beneath the epithelium. The histopathological analysis of the lesion revealed a minute carcinoid tumor ([Fig. 1] d). This case illustrates the differential diagnosis between three lesions which appear very similar: an erosion, a flat early carcinoma, and a minute carcinoid, and shows the utility of high-resolution magnification endoscopy with narrow-band imaging in differentiating them.

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Fig. 1 a A diminutive, flat, reddened lesion measuring less than 3 mm with the appearance of an erosion at the posterior wall of the greater curvature of the stomach. b Narrow-band imaging demonstrated that at the center of the lesion, the pit structure had disappeared. c High-resolution magnification endoscopy revealed that the subepithelial capillary network was well preserved, but underneath the epithelium a faint yellowish hue could be seen. d Endocrine nest/microcarcinoid which had grown just beneath the epithelium.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

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References

  • 1 Yao K, Iwashita A, Kikuchi Y. et al . Novel zoom endoscopy technique for visualizing the microvascular architecture in gastric mucosa [review].  Clin Gastroenterol Hepatol. 2005;  3 (7 Suppl 1) S23-26
  • 2 Yao K, Iwashita A, Tanabe H. et al . Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study.  Clin Gastroenterol Hepatol. 2007;  5 869-78
  • 3 Nojiri T, Ikegami M. Multiple minute carcinoids in type A gastritis: attempt at 3-D reconstruction.  Pathol Int. 2001;  51 504-510

R. Singh, MRCP

Wolfson Digestive Diseases Centre

University Hospital

Queen’s Medical Centre

Nottingham

NG7 2UH

United Kingdom

Fax: +44-115-9249924

eMail: rajvindersingh2003@yahoo.com

#

References

  • 1 Yao K, Iwashita A, Kikuchi Y. et al . Novel zoom endoscopy technique for visualizing the microvascular architecture in gastric mucosa [review].  Clin Gastroenterol Hepatol. 2005;  3 (7 Suppl 1) S23-26
  • 2 Yao K, Iwashita A, Tanabe H. et al . Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study.  Clin Gastroenterol Hepatol. 2007;  5 869-78
  • 3 Nojiri T, Ikegami M. Multiple minute carcinoids in type A gastritis: attempt at 3-D reconstruction.  Pathol Int. 2001;  51 504-510

R. Singh, MRCP

Wolfson Digestive Diseases Centre

University Hospital

Queen’s Medical Centre

Nottingham

NG7 2UH

United Kingdom

Fax: +44-115-9249924

eMail: rajvindersingh2003@yahoo.com

Zoom Image
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Zoom Image

Fig. 1 a A diminutive, flat, reddened lesion measuring less than 3 mm with the appearance of an erosion at the posterior wall of the greater curvature of the stomach. b Narrow-band imaging demonstrated that at the center of the lesion, the pit structure had disappeared. c High-resolution magnification endoscopy revealed that the subepithelial capillary network was well preserved, but underneath the epithelium a faint yellowish hue could be seen. d Endocrine nest/microcarcinoid which had grown just beneath the epithelium.