engleski

AUTOIMMUNE GASTRITIS RELATED MULTPLE GASTRIC POLYPS DIAGNOSED AS NEUROENDOCRINE TUMOR IN A SLE PATIENT

Introduction: Autoimmune gastritis (AIG) is underdiagnosed. The prevalence of gastric Neuroendocrine tumors (NETs) in Europe per 10, 000 population is estimated to be 0.32. The over-all cancer risk in SLE is slightly increased. Case presentation: A 55-year-old female patient was diagnosed with mild systemic lupus for 9 years without any major organ involvement. After 5 years she felt general weakness, fatigue. Microcytic anemia, low vitamin B12 were found while SLE was in remission. Multiple gastric polyps (about 20) of different size (< 2 cm) were verified by gastroscopy. The initial pathohistological finding indicated intestinal metaplasia, but the patient did not opt for electroresection. After 4 years a repeated biopsy of the gastric polyp was in favor of well-differentiated NET gradus 1 CgA positive Ki 67 1-2% according to 2010 WHO histologic classification. Octreoscan showed a suspected lesion in the antrum of the stomach with increased somatostatin receptor density. PET scan was negative. Anti parietal cells antibody ( APCA) was positive, levels of gastrin and gastrin 17 were high. H. pylori stool antigen was negative aswell as anti-H. pylori antibodies anti-HP-IgG. Endoscopic mucosectomia was done , 9 polyps were removed with Ki 67< 3%. Parenteral Vitamin B 12 was administered. Additionally, the patient had autoimmune thyroiditis. General prognosis is good. Conclusion: Type I gastric NETs are indolent, multifocal primary tumors. Assay of APCA, anti- intrinsic factor antibody and anti-HP-antibodies with serum gastrin (Gastrin-17) is “serological gastric biopsy”. Microcytic anemia is an earlier sign of gastric autoimmunity due to achlorhydria and pernicious anemia in advanced disease.

NET, autoimmune gastritis, SLE

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