An unusual association of folic acid deficiency with gastric neuroendocrine tumor type I

Year 2023, , 51 - 57, 29.01.2023

Victoria Gorciac , Oana Bogdana Barboi Ion Negura Laurentiu Sorodoc Catalina Lionte

https://doi.org/10.46310/tjim.1098540

Abstract

The association of gastric neuroendocrine tumour type I with macrocytic anaemia due to vitamin B12 deficiency is commonly encountered. The etiological cause of macrocytic anaemia must always be precisely established for the subsequent treatment guidance. We present the case of a 63-year-old patient admitted for marked physical asthenia, palpitations, abdominal pain, flatulence, paresthesia in the upper and lower limbs and concentration difficulties. Clinical examination revealed pale, dry skin, Hunter's glossitis, and tachycardic heart sounds. Bloodwork showed pancytopenia with macrocytic normochromic anaemia, vitamin B12 within normal limits, but with low folic acid levels. The reticulocyte crisis was documented on day three after initiating folic acid treatment. Exploration by upper digestive endoscopy and colonoscopy described multiple polypoid tumours in the greater curvature of the stomach. The histopathological and immunohistochemical examination lead to the diagnosis of gastric neuroendocrine tumours (NET) type G1. To our knowledge, there are no reports about an association of this type of tumour with folate deficiency-induced anaemia.

Keywords

Macrocytic anemia, folic acid deficiency, gastric neuroendocrine tumor type G1, autoimmune gastritis

References

• Nasir A, Coppola D, eds. Neuroendocrine Tumors: Review of Pathology, Molecular and Therapeutic Advances. 1st ed. New York, NY: Springer; 2016.
• Vannella L, Lahner E, Annibale B. Risk for gastric neoplasias in patients with chronic atrophic gastritis: a critical reappraisal. World J Gastroenterol. 2012 Mar 28;18(12):1279-85. doi: 10.3748/wjg.v18.i12.1279.
• Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, Washington KM, Carneiro F, Cree IA; WHO Classification of Tumours Editorial Board. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020 Jan;76(2):182-8. doi: 10.1111/his.13975.
• Gonzalez HH, Acosta M., Yazji G, Bromer MQ. Type 1 gastric neuroendocrine tumor found on endoscopic polypectomy. Cureus. 2019 Mar 6;11(3):e4193. doi: 10.7759/cureus.4193.
• Marignani M, Delle Fave G, Mecarocci S, Bordi C, Angeletti S, D'Ambra G, Aprile MR, Corleto VD, Monarca B, Annibale B. High prevalence of atrophic body gastritis in patients with unexplained microcytic and macrocytic anemia: A prospective screening study. Am J Gastroenterol. 1999 Mar;94(3):766-72. doi: 10.1111/j.1572-0241.1999.00949.
• Li TT, Qiu F, Qian ZR, Wan J, Qi XK, Wu BY. Classification, clinicopathologic features and treatment of gastric neuroendocrine tumors. World J Gastroenterol. 2014 Jan 7;20(1):118-25. doi: 10.3748/wjg.v20.i1.118.
• Coffey-Vega K, Gentili A, Vohra MI, Kuan-Hua Chen D. Folate deficiency. Jul 20, 2022. Available at: https://emedicine.medscape.com/article/200184-overview. Accessed August 24, 2022.
• Merola E, Sbrozzi-Vanni A, Panzuto F, D'Ambra G, Di Giulio E, Pilozzi E, Capurso G, Lahner E, Bordi C, Annibale B, Delle Fave G. Type I gastric carcinoids: A prospective study on endoscopic management and recurrence rate. Neuroendocrinology. 2012;95(3):207-13. doi: 10.1159/000329043.
• Shah MH, Goldner WS, Benson AB, Bergsland E, Blaszkowsky LS, Brock P, Chan J, Das S, Dickson PV, Fanta P, Giordano T, Halfdanarson TR, Halperin D, He J, Heaney A, Heslin MJ, Kandeel F, Kardan A, Khan SA, Kuvshinoff BW, Lieu C, Miller K, Pillarisetty VG, Reidy D, Salgado SA, Shaheen S, Soares HP, Soulen MC, Strosberg JR, Sussman CR, Trikalinos NA, Uboha NA, Vijayvergia N, Wong T, Lynn B, Hochstetler C. Neuroendocrine and Adrenal Tumors, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021 Jul 28;19(7):839-68. doi: 10.6004/jnccn.2021.0032.
• Kulke MH, Shah MH, Benson AB, Bergsland E, Berlin JD, Blaszkowsky LS, Emerson L, Engstrom PF, Fanta P, Giordano T, Goldner WS, Halfdanarson TR, Heslin MJ, Kandeel F, Kunz PL, Kuvshinoff BW, Lieu C, Moley JF, Munene G, Pillarisetty VG. Neuroendocrine tumors, version 1.2015. JNCCN Journal of the National Comprehensive Cancer Network. 2015 Jan 1;13(1):78-108. doi: 10.6004/jnccn.2015.0011.
• Delle Fave G, O'Toole D, Sundin A, Taal B, Ferolla P, Ramage JK, Ferone D, Ito T, Weber W, Zheng-Pei Z, De Herder WW, Pascher A, Ruszniewski P; Vienna Consensus Conference participants. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. Neuroendocrinology. 2016;103(2):119-24. doi: 10.1159/000443168.
• Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014 Aug;166(4):496-513. doi: 10.1111/bjh.12959.
• Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012 Nov 14;18(42):6036-59. doi: 10.3748/wjg.v18.i42.6036.
• Kulke MH, Anthony LB, Bushnell DL, de Herder WW, Goldsmith SJ, Klimstra DS, Marx SJ, Pasieka JL, Pommier RF, Yao JC, Jensen RT; North American Neuroendocrine Tumor Society (NANETS). NANETS treatment guidelines: Well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas. 2010 Aug;39(6):735-52. doi: 10.1097/MPA.0b013e3181ebb168.
• Spampatti MP, Massironi S, Rossi RE, Conte D, Sciola V, Ciafardini C, Ferrero S, Lodi L, Peracchi M. Unusually aggressive type 1 gastric carcinoid: A case report with a review of the literature. Eur J Gastroenterol Hepatol. 2012 May;24(5):589-93. doi: 10.1097/MEG.0b013e328350fae8.