Question 16#

Type III gastric carcinoid tumors:

a. Often do not require resection
b. Are associated with hypergastrinemia
c. Are sporadic lesions
d. Have better outcomes than type I and II tumors

Correct Answer is C


Type III gastric carcinoids are sporadic tumors, most often solitary (usually > 2 cm), occur more commonly in men, and behave more aggressively than types I and II. Unlike types 1 and II, they are not associated with hypergastrinemia. Type I gastric carcinoids are the most common type of gastric carcinoid, and occur in patients with chronic hypergastrinemia secondary to pernicious anemia or chronic atrophic gastritis. Type II is rare, and is associated with MEN1 and ZES. Gastric carcinoids should all be resected, and small lesions ( <2 cm) confined to the mucosa may be treated endoscopically with endoscopic mucosal resection (EMR) if there are only a few lesions ( <5) and if margins are histologically negative. Locally invasive lesions, or those >2 cm, should be removed by radical gastric resection and lymphadenectomy. Survival is excellent for node-negative patients (>90% 5-year survival); node-positive patients have a 50% 5-year survival. The 5-year survival for patients with type I gastric carcinoid is close to 100%; for patients with type III lesions, the 5-year survival is less than 50%. Most type III patients have nodal or distant metastases at the time of diagnosis, and some present with symptoms of carcinoid syndrome.