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Gastric neuroendocrine tumor, type I.
Stomach, Corpus
Haematoxylin & Eosin (H&E)
33 years
Vitamin B12 deficiency and megaloblastic anemia. Infection with Enterobius vermicularis. History of ameba infection. Clinical questions: Parasitosis? Ulcus? Lipoma?
Gastric biopsies show a mucosal infiltration by a monotonous appearing tumor with a nested and trabecular architecture. There are no discernable mitoses. The covering mucosa shows extensive chronic inflammation with atrophy of oxyntic glands and complete intestinal metaplasia. In addition, there is acute inflammation of the surface epithelium caused by the mass effect of the underlying tumor.
The tumor shows strong positivity for chromogranin A and synaptophysin confirming the diagnosis of a neuroendocrine tumor. The proliferation rate (Ki-67) is lower than 2%, resulting in the final diagnosis of a well differentiated neuroendocrine tumor (G1).
Gastro-entero-pancreatic neuroendocrine neoplasms are graded according to the number of mitoses and/ or proliferation rate (Ki-67). G1: <2 mitoses/10 HPF and/or Ki-67 ≤2%; G2: 2-20 mitoses/10 HPF and/or Ki-67 3-20%; G3: >20 mitoses/10 HPF and/or Ki-67 >20%. Neuroendocrine tumors arising in the background of autoimmune gastritis (type I) typically exhibit a favorable outcome.
Philippe Brunner, University of Basel
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