Patients were evaluated for the presence of specific symptoms; the presence of autoimmune disorders and the presence of other gastrointestinal malignancies in other family members were also recorded. The evaluation of response to treatment was www.selleckchem.com/products/MG132.html defined using established WHO criteria. RESULTS: We studied twenty consecutive patients with a mean age of 55.1 years. The mean follow-up period was 83 mo. Twelve patients had regional lymph node metastases and 8 patients had liver metastases. The primary tumor mean diameter was 20.13 �� 10.83 mm (mean �� SD). The mean Ki-67 index was 6.8% �� 11.2%. All but one patient underwent endoscopic or surgical excision of the tumor. The disease was stable in all but 3 patients who had progressive liver disease. All patients remained alive during the follow-up period.

CONCLUSION: Metastatic GCA1 carries a good overall prognosis, being related to a tumor size of �� 1 cm, an elevated Ki-67 index and high serum gastrin levels. Keywords: Metastatic gastric carcinoids, Gastrin, Chromogranin A, Somatostatin analogues, Stomach neuroendocrine tumor Core tip: Metastatic gastric carcinoid type 1 (GCA1) are extremely rare and there is no data regarding their natural history, treatment and prognosis. Based on our study, metastatic GCA1 carries a good overall prognosis. Metastatic spread appears to be related to a tumor size of �� 1 cm, an elevated Ki-67 index, and to high serum gastrin levels. Endoscopic surveillance is extremely important for follow-up. Surgical resection should be performed only in patients in whom total tumor excision is expected.

Although still controversial, somatostatin analogues could be considered as first line treatment to lower the elevated gastrin levels and suppress enterochromaffin like cell hyperplasia. INTRODUCTION Gastric carcinoids (GCAs) are neuroendocrine tumors (NETs) of the gastric mucosa originating from enterochromaffin like (ECL) cells[1]. GCAs arise either spontaneously or in response to a chronic hypergastrinemia state; due to their rarity (only 2% of all carcinoids and 8.7% of gastrointestinal carcinoids)[2,3], the predictors of metastatic disease have not been systematically addressed. GCAs are divided into three distinct types. Type 1 (GCA1) represents the majority (approximately 75%) and is associated with chronic atrophic gastritis and autoimmune destruction of parietal cells.

Type 2 (GCA2) (approximately 5%-10%) occurs almost always in the context of Multiple Endocrine Neoplasia type 1 (MEN1). Both types 1 and 2 GCAs occur in the setting of elevated serum gastrin which exerts a trophic effect on gastric enterochromaffin-like (ECL) cells leading to neuroendocrine cell hyperplasia and multifocal polypoid carcinoid tumors. These tumors are well differentiated and carry an excellent overall Entinostat prognosis. Type 3 GCAs (15%-25%) are not related to hypergastrinemia and follow an aggressive course[4-6].