• 53 y/o • Upper abd pain/burning, reflux• 9/2011 – EGD – polypoid lesion in stomach on

EGD, started on omeprazole– Path – carcinoid, invasive to muscularis,

metaplasia

• 10/2011 Hampton VA GI– EGD – several polypoid lesions, 1 lesion ulcerated, – Biopsy – carcinoid– Heme/Onc, Surgery evals

• 2/2012 Hampton– Attempted endoscopic resection

• Masses 2cm, 5cm, 8cm from GEJ

• 4/2012 Richmond VA

• PMH/PSH: none• Meds: omeprazole• Social: ½ PPD tobacco, quit drugs/EtOH 4

years ago

• 5/8– Exploration– gastrectomy

• Path– GEJ carcinoids, posterior wall– 0/10 nodes – 2.1 cm– Well differentiated, into muscularis

Type 1 – associated with atrophic gastritisType 2 – sporaticType 3 – associated with gastrinoma, MEN1 (type 2 in other system)Type 4 – other endocrine carcinomas or mixed tumors

SurvivalType 1 – 5y=96.1%, 10y=73.9%Type 2 – 5y=95%+Type 3 – 5y=50-75%Type 4 – 5y=33%, 10y=22%

Treatment recommendationsType 1- endoscopic removal of 5 lesions up to 10mm antrectomy for >5 lesions to 10mm lesions >10mm require surgical removal serosal involvement or spread outside stomach – gastrectomyType 2- treat gastrinoma, endoscopic <10mm or surgical resection >10mm Type 3,4- laparotomy, local excision

Treatment recommendationsType 1- EMR of 5 lesions up to 10mm, confined to submucosa, confirm neg margins EGD every 6-12m recurrence – surgical resection based on extent of disease consider antrectomy – some support in literature lesions>10mm/more invasive – wedge resection, subtotal/total gastrectomy based on extent of disease case reports of octreotide use in non-surgical candidatesType 2- treat gastrinoma, endoscopic <10mm or surgical resection >10mm Type 3- laparotomy, total or near total gastrectomy, node dissection (more aggressive)

Treatment recommendationsType 1- EMR, polypectomy of 5 lesions up to 10mm, confined to submucosa consider antrectomy – some support in literature consider observation/repeat EGD lesions<10mm case reports of octreotide use in non-surgical candidatesType 2- treat gastrinoma, endoscopic <10mmType 3- laparotomy, total or near total gastrectomy, node dissection (more aggressive)