Klinik für Innere Medizin, Albertinen-Krankenhaus, Hamburg, Germany.
Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Z Gastroenterol. 2021 Mar;59(3):255-258. doi: 10.1055/a-1348-2727. Epub 2021 Jan 27.
Depending on etiology, prognosis and malignant potential, recent S2k guideline differentiates gastric neuroendocrine tumors (gNET) in 4 types with different treatment implications.We report on a 55-year-old patient with the accidental finding of a 15 mm gNET. Apart from a prolonged use of proton pump inhibitors (PPI) for 20 years as a treatment for gastroesophageal reflux disease, there were no other associations or risk factors for gNETs. Formally, this patient would have been classified as a type III gNET, implicating gastric surgery. From a pathophysiological point of view, however, the assumed prolonged gastrin hypersecretion would have justified an assignment as a type I gNET. The gNET was resected by ESD, but histology showed an R1 situation. After cessation of PPIs, there is no recurrence so far. Besides, the initially documented numerous and large gland polyps showed an impressive regression only a few weeks after cessation of PPI.This case points to a probably underestimated gap in the present gNET classification. On the basis of present literature, the therapeutic dilemma of PPI-associated gNETs is discussed. A new assignment of PPI associated gNETs as type Ib could help to overcome this dilemma.
根据病因、预后和恶性潜能，最近的 S2k 指南将胃神经内分泌肿瘤（gNET）分为 4 种类型，具有不同的治疗意义。我们报告了一位 55 岁的患者，偶然发现 15mm 的 gNET。除了 20 年来因胃食管反流病而长期使用质子泵抑制剂（PPI）治疗外，没有其他与 gNET 相关的关联或危险因素。从形式上看，该患者将被归类为 III 型 gNET，需要进行胃切除术。然而，从病理生理学的角度来看，假设长期胃泌素分泌过多将证明其属于 I 型 gNET。该 gNET 通过 ESD 切除，但组织学显示 R1 情况。停止使用 PPI 后，目前尚无复发。此外，最初记录的大量大腺体息肉在停止 PPI 治疗数周后仅出现显著消退。该病例表明目前 gNET 分类中可能存在被低估的差距。基于目前的文献，讨论了与 PPI 相关的 gNET 的治疗困境。将与 PPI 相关的 gNET 重新归类为 Ib 型可能有助于克服这一困境。
