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Carcinoid Tumors of the Stomach

A Clinical and Radiographic Study

Aaron J. Binstock1, C. Daniel Johnson1, David H. Stephens1, Ricardo V. Lloyd2 and Joel G. Fletcher1

1 Department of Radiology, Mayo Clinic, 200 First St. S.W., Mayo E2-B, Rochester, MN 55905.
2 Department of Pathology, Mayo Clinic, 200 First St. S.W., Hilton 1142 D, Rochester, MN 55905.



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  		Fig. 1A. —69-year-old woman with hypergastrinemia and chronic atrophic gastritis. Contrast-enhanced CT scan obtained using oral contrast material shows small enhancing mucosal or submucosal polyp (arrow) along lesser curvature of stomach.

 


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  		Fig. 1B. —69-year-old woman with hypergastrinemia and chronic atrophic gastritis. Contrast-enhanced CT scan obtained at different level than A reveals another small mucosal or submucosal polyp surrounded by oral contrast material (arrow). Endoscopy showed multiple fundic and body type I gastric carcinoid tumors.

 


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  		Fig. 2. —Double-contrast upper gastrointestinal radiograph of 60-year-old man with chronic atrophic gastritis, pernicious anemia, and type I gastric carcinoid tumors. Image shows solitary 5-mm polyp (arrow) along posterior wall of body of stomach. Endoscopy (not shown) revealed multiple small fundic and body submucosal type I gastric carcinoid tumors.

 


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  		Fig. 3A. —49-year-old man with multiple endocrine neoplasia, type I, Zollinger-Ellison syndrome, and type II gastric carcinoid tumors. Double-contrast upper gastrointestinal image shows multiple nodular masses (arrowheads) and thickened rugal folds involving fundus and body of stomach. Duodenal sweep is displaced to right (arrows) as a result of islet cell tumor in pancreatic head.

 


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  		Fig. 3B. —49-year-old man with multiple endocrine neoplasia, type I, Zollinger-Ellison syndrome, and type II gastric carcinoid tumors. Unenhanced CT scan obtained using oral contrast material shows multiple polypoid gastric masses and diffuse gastric wall thickening.

 


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  		Fig. 3C. —49-year-old man with multiple endocrine neoplasia, type I, Zollinger-Ellison syndrome, and type II gastric carcinoid tumors. Unenhanced CT scan obtained 3.5 cm caudad to B shows densely calcified mass (arrow) in pancreatic tail, representing pancreatic islet cell tumor.

 


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  		Fig. 4. —Contrast-enhanced CT scan (obtained without oral contrast material) of 60-year-old woman with type III (solitary) gastric carcinoid tumor reveals localized thickening of the posterior gastric wall (arrows) with diffuse liver, splenic, and perigastric lymph node metastases (arrowheads).

 


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  		Fig. 5. —Drawing shows pathophysiologic schema for development of different types of gastric carcinoid tumors. Type I carcinoid tumors are small benign tumors, arising in setting of chronic atrophic gastritis and chronic hypergastrinemia. Type II tumors can be large and polypoid; arise in patients with multiple endocrine neoplasia-type I and Zollinger-Ellison syndrome; and are prone to nodal metastasis. Type III tumors, which are not associated with hypergastrinemic state, are large, sporadic, solitary tumors prone to nodal and hepatic metastases, as well as to carcinoid syndrome.

 

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