Multiple neuro-endocrine tumours complicating chronic atrophic gastritis: the cloak that hides the dagger

Abstract

Neuro-endocrine tumours of the stomach are most likely to be seen as a complication of chronic atrophic gastritis and are usually multiple, small and indolent. Much more rarely, similar tumours can occur in Zollinger-Ellison syndrome and those tumours are also usually relatively benign. Thus most neuro-endocrine tumours of the stomach, especially when multiple, are treated relatively conservatively. Here we present two cases where the initial biopsies suggested that scenario but further investigations indicated more aggressive tumours, which ultimately represented mixed adeno-neuroendocrine carcinomas (MANECs) and frank adenocarcinomas, demanding a much more radical management strategy. Whislt therapeutic conservatism is appropriate for small and multiple neuro-endocrine tumours complicating chronic atrophic gastritis, the potential for other complications of chronic atrophic gastritis in the stomach, namely MANECs and adenocarcinoma, should always be borne in mind and evidence for those tumours sought by the multi-disciplinary team.