Gastric carcinoid tumors with aggressive lymphovascular invasion and lymph node metastasis

We report a patient with multiple gastric carcinoid tumors without hypergastrinemia. An abdominal computed tomography (CT) scan was performed in a 66-year-old Japanese man who had abdominal discomfort. An abnormal, round, 2.5 cm mass close to the lesser curvature of the stomach was detected. Multiple small gastric carcinoid tumors were also detected by endoscopy. A total gastrectomy with lymph node dissection was performed after it was determined that the round mass was a lymph node metastasis of carcinoid tumor. Further pathological investigation of the surgical specimen revealed multiple gastric carcinoid tumors with severe lymphovascular invasion. The carcinoid tumors in the present patient were not related to hypergastrinemia. These lesions could not be grouped as any of the three types of gastric carcinoid tumors in the recent classification. Furthermore, as a simple distal gastrectomy is the standard treatment for multiple carcinoid tumors of the stomach, we recommend that a precise histopathological evaluation should be performed before an appropriate curative surgical treatment is selected.