大韓放용f線훌훌學會픔 第 26卷 第 l 號 pp. 145 - 147, 1990 J ou rnal of Korean Radiological Society‘ 26 (1 ) 145-147‘ 1990

Gastric Carcinoid with Upper Gastrointestinal Bleeding

〈 국문초록 〉

- A Case Report-

Hye Young Choi, M.D. , Young Ho Auh, M.D. , Mun Gyu Lee, M.D. , Kyung Sik Cho, M.D. , Dae Chul Suh, M.D. , Tae Hwan Lim, M.D.,

Shi Joon Yoo, M.D.

Department of Diagnostic Radiology, CoJlege of Medicine , Ulsan University

위장관 출혈을 동반한 위유암 -1 예 보고-

울산의대 의학부 진단땅사선과학교실

최혜영·오용호·이문규·조경식

서대철·임태환·유시준

위 장판 유암은 주로 소장파 맹 장에 잘 생 기 는 종양우로 위 장에 서 의 말생률은 아주 낮은 것우로

알려져 있다.

위 유암은 땅사선학적 소견상으로도 대부분이 펑활근종파 같은 정악하 종양파 같은 양상으로

냐타냐므로 드물긴 하지만 감별을 요하는 종양으로 생각되어 저자들은 1예를 경험하였기에 마른

문헌고찰과 함께 보고하는 바이 다.

- Abstract-

Carcinoid tumor usually occur in the gastroi ntestinal trac t and occasionally find in the lung ,

and the incidences of carcinoid tumors are 85 % and 10 % respective lyl) Although gas trointes­

tinal tract is most commonly involved , gastric involvement is very rare

Carcinoid tumors arise from Kulchitsky cells originating in the neural c res t. Kulchitsky cells

are fo und throughout the gas tro intest inal tract from the cardia to the anus

We recently experienced a gastric carcino id tumor and this report describes a case with

endoscopic , radiologic , and pathologic findings and discussed together with a pe rtinent review

。f the li teratures

Index Words: Stomach , neo plasms 72.3 16

Stomach, radiography 72.123 1

이 논문은 1989년 11월 1 5일 성수하여 1 989년 11월 23일에 채택되었응 Received Nove mber 15 , accepted November 23 , 1989

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- 大韓放射線훌훌學會註 : 第26卷 第 l 號 1990

Case

A 53-year-old female was admitted to the Asan

medical Center with the presentation of tarry stool

and fainting spells in August 1989. On physical

examination , she was anemic and hypotensive sta­

te. Laboratory studies demonstrated a hemoglobin

of 8.6 gldL and hematocrit of 25 %.

Gastroendoscopic findings revealed smo-

oth-marginated round elevated mass with central

hemorrhagic umbilicated spot in the anterior wall

of the lower body of the stomach (Fig. 1). An

upper G-I study demonstrated well-marginated fil­

ling defect measuring about 1.5 cm with central

ulceration at the lower body of the stomach (Fig.

2) . Subtotal gastreatomy with gastrojejunostomy

was performed in conjunction with 27 regional

Iymph nodes dissection. The gross specimen

showed protruding polypoid mass measuring 1 cm

in diameter with central umbilication in anterior

wall of the lower body of the stomach. The path­

ologic specimen revealed 2 metastatic Iymph

nodes among 27 resected Iymph nodes . Micros­

copic examination showed small uniform cells

arranged in small nests and strands with no mitotic

figures. The 미umps of the tumor cells were sepa­

rated by moderate amount of fibrous stroma (Fig.

3) .

1. 3. Fig. 1. Gastroendoscopic finding, Smooth-marginated round protruding mass which central hemorrh agic ulceration at the lower bodyb 01 the stomach Fig. 3. Microsco pi c findings , Small uniform sized and round shaped carcinoid tumor cell s arranged in diffe rent patterns‘ nests and strand s, and are separated by moderate amoun t of fibrous stroma

Fig. 2. UGr study, about 1.5 cm sized lilling defect with small ce ntral ulce rati on at the lower body 01 the stomach

Discussion

Although the clinical , radiological , and patholo­

gical features of the carcinoid tumors have been

extensively analyzed , the preoperative diagnosis is

still remainded a difficult problem . Most of all , the

gastric carcinoid tumors are very rare and repre­

sent 0.3 % of all gastric tumors and 3 % of all

carcinoid tumors2). The gastric carcinoid tumors

are demonstrated either as incidental findings or

usually during attemps to diagnose the source of

gastrointestinal bleeding.

The radiologic findings of gastric carcinoid tum­

ors are non-specific and variable features. Gastric

carcinoid tumors are commonly diagnosed from

gastrofiberscopic biopsy or surgical specimen .

Balthazar et al classified radiographic findings of

gastric carcinoid tumors into 4 groups: 1. Single

intramural defects simulating leiomyoma , 2. Mul­

tiple gastric polyps , 3. Large gastric ulcer , and 4.

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- Hye Young Choi , et al.: Gastric Carcinoid with Upper Gastrointestinal Bleeding -

Polypoid intraluminal lesion. The single intramural

defect group are the most common t ~'pe and repo­

rted in about two-thirds of the cases. These tumo­

rs are often misinterpreted as gastric leiomyoma at

radiographic study and misdiagnosed at endoscopic

biopsy because of the submucosal location of

tumors3). Our case represented sigle intramural

filling defect at radiographic study and we also

misinterpreted as leiomyoma or e이야기c pancreas.

Although this type of radiographic findings is

more commonly associated with gastric leiomy­

omas, gastric carcinoid should be included as dif­

ferential diagnosis .

Gastric carcinoid tumors frequently ulcerate and

often bleed regardless of size. Martin et al repor­

ted about 10 % hematemesis in gastric carcinoid

tumors4). Schoenfeld et al , in the review of 42

patients from the literature , found significant gas­

trointestinal bleeding in 5 patients , an incidence of

12 %5) .

Our case also had a sign of melena and showed

an intramural mass with central ulceration at the

lower body of the stomach in upper G-I study.

Carcinoid syndrome is seen in only 10 % of the

gastric carcinoids , however this rate increased up

to 28 % among cases with metastatic lesions in the

liver6). The gastric carcinoids most commonly

metastasize to the regional Iymph nodes and liver

Whole incidence of metastasis is about 25 % in the

gastrointestinal carcinoids and about 17 % in the

gastric carcinoids 7) . Our case represented of 2

metastatic Iymph nodes and diagnosed malignant

carcinoid tumor.

The carcinoid tumors are usually not aggressive , but surgical operation is the choice of the treatm­

ent because of chronic blood loss and potential

metastasls

The most non-functioning gastric carcinoids

have a good prognosis , although late metastasis to

the liver may be more common. The five-year

survival rate is about 93 % in localized carcinoid

tumor but drops to 23 % in the metastatic carci­

noid tumor2) .

REFERENCES

1. MacDonald ]S: Carcinoid tumors. In : DeVita VT ,

Hellman S, Rosenberg SA , eds. Cancer. Phi

ladelphia: Lippincott 1223-1228, 1984

2. Godwin ] D: Carcin oid tumors. An analysis of 2837

cases. Cancer 36: 560.569. 1975

3. Balthazar E] , Megibow A, Bryk D, et al: Gastric

carcinoid tumors. Radiographic features in eight

cases. AJR 139. 1123-1127, 1982

4. Martin ]D ] r, Atkins EC ] r: Carcinoid 01 the sto

mach. Review 01 reported cases. S urgery 3 1

698 , 704, 1952

5. Schoenfeld R, Cahan ] , Dyer R: Gastric carcin oid

tumor. An unusual cause 01 hematemesis. A rch ln.

tern Med 104: 649-652, 1959

6. Nizuma K, Shibuya H, Totsuka M, Hyyasaka H

Carcinoid 01 the stomach. A case report dnd review

of 100 cases reported in }apan. Annales Chirurgiae

et Gynaecologiae 72: 23 , 27, 1983

7. Thompson NW , Coon WW: Carcinoid 01 the s to.

mach. Am } Surg 108: 798-801 , 1964

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