ENDOSKOPİDE NADİR RASTLANAN POLİPLER: TİP 1 GASTRİK NÖROENDOKRİN TÜMÖR NET-TİP 1

Abstract

Mide nöroendokrin tümörleri nadir görülür ancak sıklığı gittikçe artmaktadır. Bu tümörler enterokromaffin benzeri hücrelerden köken alırlar. Tüm GIS nöroendokrin tümörleri içerisinde % 3 oranında görülürler. Klinik görünümü genellikle nonspesifiktir. Gastrik nöroendokrin tümörler ile pernisiyöz anemi, atrofik gastrit ve Zollinger-Ellison sendromu arasında bir birliktelik söz konusudur. Hastalarda polipoid lezyonlar tek ya da çok sayıda olabilir, ancak mukoza ve submukozada sınırlıdırlar. Üç tip mide nöroendokrin tümörü tanımlanmıştır. Tip1 ve Tip2 mide nöroendokrin tümörler hipergastrinemi ile ilişkilidir ve genellikle düşük metastaz potansiyeline sahiptirler. Tip3 mide nöroendokrin tümörler hipergastrinemi ile ilişkisizdir ve yüksek metastaz potansiyeline sahiptirler. Tip 1 ve Tip 2 mide nöroendokrin tümörler çoğunlukla multifokaldir, ancak Tip 3 tümörler genellikle soliter tümörlerdir. Mide nöroendokrin tümörün gelişiminden gastrin, genetik faktörler, büyüme faktörleri ve matriks regülasyon proteinleri gibi birçok faktör sorumlu tutulmuştur. Tedavi öncesi uygun bir değerlendirme, gastrik adenokarsinom ve displazi gibi eş zamanlı lezyonların varlığı kadar malign dönüşümlerin de ekarte edilebilmesi için gereklidir. Çalışmamızda, kronik atrofik gastrit zemininde gelişmiş ve endoskopik olarak rezeke edilmiş, NET-Tip1 polip olgusunu sunuyoruz

Keywords

• Nöroendokrin tümör NET,gastrik polip,gastroskopi

RARE POLYPS IN ENDOSCOPIC EXAMINATION: TYPE 1 GASTRIC NEUROENDOCRIN TUMOUR NET-TYPE 1

Abstract

Gastric neuroendocrine tumors are rare, but are increasing in occurrence. These tumors originate from enterochromaffin-like cells. These tumors are less than 3 % of all gastrointestinal neuroendocrine tumors.The clinical presentation is often non-specific. There is a definitive association between the occurrence of gastric neuroendocrine tumors and pernicious anemia, atrophic gastritis and Zollinger-Ellison syndrome. These patients had single or multiple polypoid lesions with tumor extension limited to mucosa or submucosa. Three subtypes of gastric neuroendocrine tumors were defined. Types 1 and 2 gastric neuroendocrine tumors are associated with hypergastrinemia and usually have low metastatic potential. Type 3 gastric neuroendocrine tumors are not associated with hypergastrinemia and have a higher potential for metastatic disease. Most of types 1 and 2 gastric neuroendocrine tumors are multifocal; however type 3 tumors are often solitary tumors. The development of a gastric neuroendocrine tumor has been responsible for many factors such as gastrin, genetic factors growth factors and matrix regulating proteins. A proper evaluation before therapy is indicated in order to rule out both the malignant transformation as well as the presence of synchronous lesions, such as dysplasia or gastric adenocarcinoma. We presented NET type-1 gastric polyp case which improved on the base of chronic atrophic gastritis and endoscopically resected during gastroscopic intervention

Keywords

• Neuroendocrine tumor NET,Gastric polyp,gastroscopy

References

1. ) Klöppel G, Heitz PU, Capelle C, Solcia E. pathology and nomenclature of human gastrointestinal neuroendocrin (carcinoid) tumors and related lesions. World J Surg ;20:132-41. ) Rindi G. Clinopathologic aspect of gastric neuroendocrine tumors. Am J Surg Pathol ;19:20-9. ) Rindi G, Bordi C, Rappel S, et al. Gastric carcinoids and neuroendocrine carcinomas: pathogenesis, pathology and behavior. World J Surg 1996;20168–72.
2. ) Modlin I.M, Lye K.D, Kidd M. Carcinoid tumors of the stomach. Surg Oncol 2003;12: 72.
3. ) Burkitt MD, Pritchard DM. Review article: Pathogenesis and Management of Gastric Carcinoid Tumours. Aliment Pharmacol Ther ;24:1305-20.
4. ) Demir M, Gen R, Hilmi A. Gastric carcinoid tumors. Ege Journal of Medicine 2011;50:73
5. ) Gough D, Thompson G, Crotty T, et al. Diverse clinical and pathologic features of gastric carcinoid and the relevance of hypergastrinemia. World J Surg 1994;18:472–
6. ) Houghton J, Wang TC. Helicobacter pylori and gastric cancer: A new paradigm for inflammation-associated epithelial cancers. Gastroenterology 2005;128:1567–78.
7. ) Kagawa J, Honda S, Kodama M, et al. Enterocromaffin- like cell tumor induced by Helicobacter pylori infection in Mongolian gerbils. Helicobacter 2002;7:390–7.
8. ) Sato Y, Iwafuchi M, Ueki J, et al. Gastric carcinoid tumors without autoimmune gastritis in Japan: A relationship with Helicobacter pylori infection. Dig Dis Sci 2002;47:579–85.

9. ) Bordi C, Azzoni C, Feraro G, et al. Sampling strategies for analysis of enterochromaffin-like cell changes in Zollinger– Ellison syndrome. Am J Clin Pathol 2000;114: –25.
10. ) Nakamura S, Lida M, Yao T, et al. Endoscopic features of gastric carcinoids. Gastrointest Endosc 1991;37:535–8.
11. ) Naitoh H, Kumashiro R, Teshima K, et al. A minute, solitary carcinoid of the stomach with a lymph node metastasis: a case report. Gan No Rinsho 1988;34:908–13.
12. ) Picus D, Glazer H, Levitt R, et al. Computed tomography of abdominal carcinoid tumors. Am J Radiol 1984;143:581–4.
13. ) Demir M, Ataseven H, Gen R. Tip 1 Mide Karsinoid Tümörün Endoskopik Polipektomi ileTedavisi: Bir Olgu Sunumu ve Literatürün İncelenmesi MN Dahili Bilimler 2009;1:31-6.
14. ) Modlin I.M, Lye K.D, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer ;97:934–59. Yazının alınma tarihi:30.06.2014 Kabül tarihi:16.09.2014 On line basım:01.10.2014