- Email: [email protected]
Type 3 gastric neuroendocrine tumor with unique endoscopic features
Accepted Manuscript Title: Type 3 gastric neuroendocrine tumor with unique endoscopic features Author: Keisuke Kawasaki Shotaro Nakamura Tamotsu Sugai Takayuki Matsumoto PII: DOI: Reference:
S1590-8658(16)30513-8 http://dx.doi.org/doi:10.1016/j.dld.2016.07.001 YDLD 3202
To appear in:
Digestive and Liver Disease
Received date: Accepted date:
29-6-2016 4-7-2016
Please cite this article as: Kawasaki K, Nakamura S, Sugai T, Matsumoto T, Type 3 gastric neuroendocrine tumor with unique endoscopic features, Digestive and Liver Disease (2016), http://dx.doi.org/10.1016/j.dld.2016.07.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Kawasaki (1)
Type 3 gastric neuroendocrine tumor with unique endoscopic features
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Running title: Type 3 gastric neuroendocrine tumor
Keisuke Kawasaki, MD a,*, Shotaro Nakamura, MD a, Tamotsu Sugai, MD b, and
a
us
cr
Takayuki Matsumoto, MD a
Division of Gastroenterology, Department of Internal Medicine, and b Department of
M
an
Diagnostic Pathology, Iwate Medical University, Morioka; Japan
* Correspondence to: Keisuke Kawasaki, MD
ed
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan
pt
Phone: +81-19-651-5111 FAX: +81-19-652-6664
Ac ce
E-mail: [email protected]
Key words: gastric neuroendocrine tumor, NBI, EUS Word count: 220 words
Page 1 of 5
Kawasaki (2)
A 69-year-old man underwent esophagogastroduodenoscopy (EGD) for gastric cancer screening. EGD showed a reddish, semi-pedunculated polypoid lesion in the middle third of the stomach (Fig. 1A). Magnifying endoscopy with narrow-band
ip t
imaging (M-NBI) revealed whitish exudates on the surface (Fig. 1B). Endoscopic ultrasonography (EUS) disclosed hyperechoic lesion in the submucosal layer (Fig. 1C).
cr
The patient was negative for anti-parietal cell and anti-intrinsic factor antibodies.
Histological examination of the endoscopically resected specimen showed that the
us
tumor was composed of uniform cells with ovoid nuclei and eosinophilic cytoplasm, proliferation of capillary-sized vessels and fibrin exudates attached to the surface. The
an
tumor had invaded deep submucosal layer and was positive for chromogranin A (Fig. 2). The mitotic cells were not evident with the Ki-67 labelling index of 4.8%. Endocrine
M
cell micronests were not detected in the biopsy specimens obtained from the surrounding mucosa. The final diagnosis was a type 3 gastric neuroendocrine tumor (G-
ed
NET) of G2, which was restricted to the submucosal layer with lymphatic permeation, but without venous permeation. Because the patient refused surgery, we decided to
pt
carefully follow-up him.
Type 3 G-NET usually has the appearance of a solitary submucosal tumor,
Ac ce
markedly dilated vessels on the surface under M-NBI and hypoechoic homogeneous lesion under EUS [1]. Our case suggests that type 3 G-NET may manifest peculiar endoscopic features characterized by mucus exudates.
Page 2 of 5
Kawasaki (3)
Reference 1. Hirai M, Matsumoto K, Ueyama H, et al. A case of neuroendocrine tumor G1 with unique histopathological growth progress. World J Gastrointest Endosc 2013; 5:
Ac ce
pt
ed
M
an
us
cr
ip t
605-609
Page 3 of 5
Ac
Page 4 of 5
Ac
Page 5 of 5
S1590-8658(16)30513-8 http://dx.doi.org/doi:10.1016/j.dld.2016.07.001 YDLD 3202
To appear in:
Digestive and Liver Disease
Received date: Accepted date:
29-6-2016 4-7-2016
Please cite this article as: Kawasaki K, Nakamura S, Sugai T, Matsumoto T, Type 3 gastric neuroendocrine tumor with unique endoscopic features, Digestive and Liver Disease (2016), http://dx.doi.org/10.1016/j.dld.2016.07.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Kawasaki (1)
Type 3 gastric neuroendocrine tumor with unique endoscopic features
ip t
Running title: Type 3 gastric neuroendocrine tumor
Keisuke Kawasaki, MD a,*, Shotaro Nakamura, MD a, Tamotsu Sugai, MD b, and
a
us
cr
Takayuki Matsumoto, MD a
Division of Gastroenterology, Department of Internal Medicine, and b Department of
M
an
Diagnostic Pathology, Iwate Medical University, Morioka; Japan
* Correspondence to: Keisuke Kawasaki, MD
ed
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan
pt
Phone: +81-19-651-5111 FAX: +81-19-652-6664
Ac ce
E-mail: [email protected]
Key words: gastric neuroendocrine tumor, NBI, EUS Word count: 220 words
Page 1 of 5
Kawasaki (2)
A 69-year-old man underwent esophagogastroduodenoscopy (EGD) for gastric cancer screening. EGD showed a reddish, semi-pedunculated polypoid lesion in the middle third of the stomach (Fig. 1A). Magnifying endoscopy with narrow-band
ip t
imaging (M-NBI) revealed whitish exudates on the surface (Fig. 1B). Endoscopic ultrasonography (EUS) disclosed hyperechoic lesion in the submucosal layer (Fig. 1C).
cr
The patient was negative for anti-parietal cell and anti-intrinsic factor antibodies.
Histological examination of the endoscopically resected specimen showed that the
us
tumor was composed of uniform cells with ovoid nuclei and eosinophilic cytoplasm, proliferation of capillary-sized vessels and fibrin exudates attached to the surface. The
an
tumor had invaded deep submucosal layer and was positive for chromogranin A (Fig. 2). The mitotic cells were not evident with the Ki-67 labelling index of 4.8%. Endocrine
M
cell micronests were not detected in the biopsy specimens obtained from the surrounding mucosa. The final diagnosis was a type 3 gastric neuroendocrine tumor (G-
ed
NET) of G2, which was restricted to the submucosal layer with lymphatic permeation, but without venous permeation. Because the patient refused surgery, we decided to
pt
carefully follow-up him.
Type 3 G-NET usually has the appearance of a solitary submucosal tumor,
Ac ce
markedly dilated vessels on the surface under M-NBI and hypoechoic homogeneous lesion under EUS [1]. Our case suggests that type 3 G-NET may manifest peculiar endoscopic features characterized by mucus exudates.
Page 2 of 5
Kawasaki (3)
Reference 1. Hirai M, Matsumoto K, Ueyama H, et al. A case of neuroendocrine tumor G1 with unique histopathological growth progress. World J Gastrointest Endosc 2013; 5:
Ac ce
pt
ed
M
an
us
cr
ip t
605-609
Page 3 of 5
Ac
Page 4 of 5
Ac
Page 5 of 5