Duodenal gastrinoma with multiple gastric neuroendocrine tumors secondary to chronic Helicobacter pylori gastritis

The American Journal of Surgical Pathology
Andrea GrinRobert H Riddell

Abstract

Helicobacter pylori (HP) has been associated with neuroendocrine tumors of the stomach and duodenum. Gastric enterochromaffin-like (ECL) cell tumors and duodenal gastrinomas have also been associated with HP gastritis in separate series but have not been reported together. With other possible causes excluded, we present a patient with HP-associated atrophy of the oxyntic mucosa that ultimately resulted in stimulation and reactive hyperplasia of gastrin-producing cells in both the antrum and proximal duodenum, the latter progressing to formation of a gastrin-producing cell nodule (gastrinoma). Both of these sources of gastrin resulted in ECL hyperplasia in the atrophied oxyntic mucosa with progression to microcarcinoids and well-differentiated neuroendocrine tumors, along with hypertrophy of residual proximal gastric parietal cells. As atrophy tends to spread from the antrum proximally, residual oxyntic mucosa was still infected with HP and offers 1 explanation for the apparent paradox of atrophic gastritis with ECL hyperplasia and neoplasia in the distal oxyntic mucosa, with proximal oxyntic mucosa showing mild hypertrophic changes in a background of typical HP gastritis.

References

Aug 28, 1998·Gastroenterology·T WatanabeM Nakao
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Nov 7, 2007·Wiener klinische Wochenschrift·Günter Klöppel, Martin Anlauf
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Citations

Jan 15, 2014·World Journal of Gastroenterology : WJG·Ting-Ting LiBen-Yan Wu
Jun 2, 2015·Archives of Pathology & Laboratory Medicine·Andrea Grin, Catherine J Streutker
Aug 8, 2013·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Shou-Jiang TangFeriyl Bhaijee
Jul 30, 2019·Khirurgiia·A V AlekberzadeE D Litovchenko
Jan 11, 2020·The Journal of Clinical Endocrinology and Metabolism·Ryan EndallJohn Burgess
Aug 30, 2016·World Journal of Gastroenterology : WJG·Yuichi SatoShuji Terai
Sep 27, 2018·Virchows Archiv : an International Journal of Pathology·Hala El-ZimaityRobert Riddell

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