Igarashi Ryo, Irisawa Atsushi, Shibukawa Goro, Soeta Nobutoshi, Sato Ai, Yamabe Akane, Fujisawa Mariko, Arakawa Noriyuki, Yoshida Yoshitsugu, Ikeda Tsunehiko, Abe Yoko, Maki Takumi, Yamamoto Shogo, Oshibe Ikuro, Saito Takuro, Hojo Hiroshi
Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.
Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.
Clin Med Insights Case Rep. 2018 Jan 10;11:1179547617749226. doi: 10.1177/1179547617749226. eCollection 2018.
Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by enterochromaffin-like cells of the stomach. Optimal management of GNETs has not yet been definitively determined. Endoscopic resection is approximately recommended for small GNETs associated with hypergastrinemia. However, endoscopic resection might present risk of perforation or positive vertical margin because neuroendocrine tumors occur in the deep mucosa, with some invading the submucosa. In this case, a patient with type A chronic atrophic gastritis had a small subepithelial lesion in a deep submucosal layer, and we diagnosed it as GNET using endoscopic ultrasound-guided fine-needle aspiration biopsy using a forward-viewing and curved linear-array echoendoscope. Moreover, our results show that laparoscopic and endoscopic cooperative surgery with regional lymph node dissection is a safe and feasible procedure for GNETs, especially those that cross to the muscularis propria. We suggest this approach as one therapeutic option for GNETs because it safely minimizes resection and is less invasive.
胃神经内分泌肿瘤（GNETs）是一种罕见的病变，其特征为胃的肠嗜铬样细胞。GNETs的最佳治疗方案尚未最终确定。对于与高胃泌素血症相关的小GNETs，大约推荐采用内镜下切除术。然而，内镜下切除术可能存在穿孔风险或垂直切缘阳性，因为神经内分泌肿瘤发生于深层黏膜，部分会侵犯黏膜下层。在此病例中，一名A型慢性萎缩性胃炎患者在黏膜下层深层有一个小的上皮下病变，我们使用前视弯曲线性阵列超声内镜通过内镜超声引导下细针穿刺活检将其诊断为GNET。此外，我们的结果表明，腹腔镜与内镜联合手术加区域淋巴结清扫术对于GNETs是一种安全可行的手术方式，尤其是那些侵犯至固有肌层的GNETs。我们建议将这种方法作为GNETs的一种治疗选择，因为它能安全地减少切除范围且侵袭性较小。
