Answer

From question on page 629

Endoscopic ultrasound showed a hypoechoic and homogeneous tumour arising from the mucosa (the second layer) and growing into the submucosa (third layer). Histology showed a carcinoid tumour with free margins (fig 3). Because the gastric lesion was solitary and gastric biopsies did not show atrophic gastritis, the diagnosis of sporadic gastric carcinoid was adopted.

Gastric carcinoid tumours are a rare disease. They account for 2% of all gastrointestinal carcinoids.¹ A classification system distinguishing three types of gastric carcinoid tumours has been proposed. Patients are often asymptomatic, with carcinoids found incidentally at endoscopy. When symptoms do occur, they are usually dyspeptic in nature. Only five previous cases of severe bleeding from gastric carcinoid, requiring surgical treatment, have been reported.² In all cases, a single gastric carcinoid of the sporadic type was found. Sporadic carcinoids have higher rates of regional lymph node involvement. Surgical resection with lymph node sampling is generally recommended, as was done in our case.³ Endoscopic ultrasound is the method of choice in identifying submucosal tumours. Although we would suggest that if a gastric submucosal tumour >1 cm is found at endoscopy, endoscopic ultrasound will distinguish different lesions arising from the gastrointestinal layers and will guide management because certain types are associated with a high malignant potential.⁴ Hence a gastric carcinoid tumour should be considered in the differential diagnosis of submucosal tumours.

Figure 3

 Histology showing a carcinoid tumour with free margins.