Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

606 Gastric Carcinoids Gastric Lymphoma

■sporadic carcinoid: often large, solitary, aggressive, metastasize early

■also occur in multiple endocrine neoplasia type I, atrophic gastritis

(often small and multiple, with better prognosis, in hypergastrinemic

states)

tests

■serum gastrin if multiple lesions

■endoscopy with biopsy for diagnosis

■endoscopic ultrasonography with biopsy for subepithelial lesion

■octreotide and CAT scans to assess for metastasis

■foregut carcinoids only rarely have elevated serotonin, so 5-HIAA not

so useful

differential diagnosis

n/a

management

■surgery with lymph node dissection for sporadic carcinoid.

■with hypergastrinemia: resect gastrinoma or the antrum in atrophic

gastritis

■medical therapy for metastatic disease with or without surgery to

reduce tumor burden.

■poor response to chemotherapy.

specific therapy

n/a

follow-up

■no specific protocol. periodic CAT scans and endoscopy

complications and prognosis

■50% 5-year survival in metastatic disease

Gastric Lymphoma...................................

LYN SUE KAHNG, MD and ROY SOETIKNO, MD, MS

history & physical

■nonspecific: abdominal, pain, anorexia, weight loss, bleeding, nau-

sea and vomiting

■adenopathy, hepatospenomegaly

tests

■CBC: anemia. LDH may be elevated. LFT: abnormalities suggesting

liver metastasis