Gastric carcinoids. An immunohistochemical and clinicopathologic study of 104 patients.

BACKGROUND

Gastric carcinoids are uncommon, and are unlike carcinoids at other gastrointestinal sites, clinically and pathologically.

METHODS

The authors studied specimens from 104 patients with gastric carcinoid, with study emphasis being placed on pathologic features, immunohistochemistry, clinical associations, and prognostic factors.

RESULTS

The average age of the 47 male patients and 57 female patients was 61 years. Twenty-seven patients had chronic atrophic gastritis, 12 had pernicious anemia, and 6 had hypergastrinemia; no patient had carcinoid syndrome. Most of the tumors were confined to the mucosa and submucosa. Lymph node metastases were present in only one patient. The tumors were argyrophilic in 84% and argentaffin in 14%. Chromogranin tested positive in all patients; serotonin was detected in one-third; other hormones were much less common. Gastrin-positive tumors were antral. Of the 62 patients with follow-up, 44 were alive without disease, 4 were alive with disease, and 14 were dead (4 died of carcinoid-related disease). None of the deceased had pernicious anemia or hypergastrinemia. The tumors in patients with a fatal outcome were 2 cm or larger.

CONCLUSION

Gastric carcinoids generally are indolent tumors, particularly when associated with pernicious anemia or hypergastrinemia or when smaller than 2 cm. Chromogranin is the most sensitive marker.