{"id":18261,"date":"2024-01-30T00:38:31","date_gmt":"2024-01-30T00:38:31","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=18261"},"modified":"2024-06-18T15:55:09","modified_gmt":"2024-06-18T15:55:09","slug":"diagnostico-e-tratamento-de-tumor-neuroendocrino-gastrico-na-gastrite-atrofica-metaplasica-autoimune","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/diagnostico-e-tratamento-de-tumor-neuroendocrino-gastrico-na-gastrite-atrofica-metaplasica-autoimune\/","title":{"rendered":"Diagn\u00f3stico e tratamento de tumor neuroend\u00f3crino g\u00e1strico na gastrite atr\u00f3fica metapl\u00e1sica autoimune"},"content":{"rendered":"\n<p>Paciente do sexo feminino, 61 anos, natural e residente em Macei\u00f3 \u2013 AL, apresenta queixas disp\u00e9pticas inespec\u00edficas e realiza exames endosc\u00f3picos regularmente. Possui hist\u00f3rico de hipertens\u00e3o arterial, anemia e tireoidite de Hashimoto e faz uso regular de anti-hipertensivos.<\/p>\n\n\n\n<p>Ao exame endosc\u00f3pico, destaca-se intensa atrofia de mucosa, predominantemente em fundo e corpo, com not\u00e1vel redu\u00e7\u00e3o das pregas g\u00e1stricas e presen\u00e7a de ilhotas de mucosa residual (pseudop\u00f3lipos) no fundo. Observa-se uma linha delimitando a mudan\u00e7a do padr\u00e3o mucoso na incisura e antro que se encontram normais. Adicionalmente, \u00e9 identificado um pequeno p\u00f3lipo s\u00e9ssil \u00fanico no corpo m\u00e9dio, em parede anterior, medindo 4-5 mm, com superf\u00edcie avermelhada e presen\u00e7a de vasos discretamente dilatados.<\/p>\n\n\n\n<div style=\"position:relative;padding-top:75%;\"><iframe id=\"panda-20ebfe22-b656-4fcc-8795-dcf1c40d122a\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=20ebfe22-b656-4fcc-8795-dcf1c40d122a\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n\n\n\n<p class=\"has-text-align-center\">V\u00eddeo da avalia\u00e7\u00e3o endosc\u00f3pica \u00e0 luz branca<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-3 is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/01\/Foto-1-retrovisao-com-atrofia-de-mucosa-2.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-1-retrovisao-com-atrofia-de-mucosa-2.jpg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Atrofia de mucosa \u00e0 retrovis\u00e3o<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/01\/Foto-2-cromoscopia-com-indigo-carmin-04-2.jpeg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-2-cromoscopia-com-indigo-carmin-04-2.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Cromoscopia com \u00edndigo carmin 0,4%<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/01\/Foto-3-ilhotas-de-mucosa-residual-pseudopolipos-no-fundo-em-detalhe-2.jpeg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-3-ilhotas-de-mucosa-residual-pseudopolipos-no-fundo-em-detalhe-2.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Mucosa residual normal (pseudop\u00f3lipos)<\/em><\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p>Os resultados anatomopatol\u00f3gicos indicam mucosa normal do antro e incisura, com pesquisa de H. pylori negativa; no corpo, \u00e9 evidenciada metaplasia intestinal leve e incompleta + atrofia glandular moderada, tamb\u00e9m com pesquisa de H. pylori negativa.<\/p>\n\n\n\n<p>Exames laboratoriais revelam eleva\u00e7\u00e3o da gastrina no valor de 190 pg\/mL (VR at\u00e9 115 pg\/mL), anticorpo anti-c\u00e9lula parietal e anti-fator intr\u00ednseco reagentes, defici\u00eancia de ferro s\u00e9rico 35 ug\/dL (VR 50-170 ug\/dL) e vitamina B12 130 pg\/mL (VR 172 a 890 pg\/mL).  A ecoendoscopia para avalia\u00e7\u00e3o do p\u00f3lipo mostra uma forma\u00e7\u00e3o hipoecog\u00eanica e homog\u00eanea em segunda camada, mucosa profunda, pass\u00edvel de ressec\u00e7\u00e3o endosc\u00f3pica, sem linfonodomegalia. <\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/01\/foto-4-ecoendoscopia-1.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/foto-4-ecoendoscopia-1.jpg\" alt=\"\" style=\"width:425px;height:auto\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Forma\u00e7\u00e3o hipoecog\u00eanica e homog\u00eanea em segunda camada, mucosa profunda, avaliada por ecoendoscopia<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n<p>Diante das caracter\u00edsticas da les\u00e3o, opta-se pela t\u00e9cnica de mucosectomia assistida por banda el\u00e1stica, com ressec\u00e7\u00e3o completa do tumor em monobloco (utilizando o dispositivo Captivator EMR da<a href=\"https:\/\/endoscopiaterapeutica.com.br\/boston\/\" target=\"_blank\" rel=\"noreferrer noopener\"> Boston Scientific<\/a>). A revis\u00e3o do leito n\u00e3o demonstra sinais de les\u00e3o residual ou complica\u00e7\u00f5es imediatas (sangramento\/perfura\u00e7\u00e3o), sendo o leito cruento fechado com um endoclipe (<a href=\"https:\/\/endoscopiaterapeutica.com.br\/produto\/boston-scientific\/resolution\/\" target=\"_blank\" rel=\"noreferrer noopener\">Resolution 360\u00ba da Boston Scientific<\/a>). O procedimento, realizado ambulatorialmente, transcorreu sem intercorr\u00eancias, com dura\u00e7\u00e3o de 30 minutos, seguido de alta.<\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-2 is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/01\/Foto-5-polipo-sessil-na-luz-branca-2.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-5-polipo-sessil-na-luz-branca-2.jpg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Vis\u00e3o em luz branca<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/WhatsApp-Image-2024-01-24-at-22.30.28.jpeg\" alt=\"\"\/><figcaption class=\"wp-element-caption\"><em>Vis\u00e3o em cromoscopia digital<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.com.br\/wp-content\/uploads\/2024\/01\/Foto-7-cromoscopia-com-indigo-carmin-04-2.jpeg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-7-cromoscopia-com-indigo-carmin-04-2.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Vis\u00e3o em cromoscopia com \u00edndigo carmin 0,4%<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/endoscopiaterapeutica.com.br\/wp-content\/uploads\/2024\/01\/Foto-8-aposicao-de-banda-elastica-2.jpeg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-8-aposicao-de-banda-elastica-2.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Aposi\u00e7\u00e3o com banda el\u00e1stica<\/em><\/figcaption><\/figure>\n<\/figure>\n\n\n\n<div style=\"position:relative;padding-top:66.66666666666666%;\"><iframe id=\"panda-056d2d48-adf6-4c5c-8d13-613952f2b48b\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=056d2d48-adf6-4c5c-8d13-613952f2b48b\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n\n\n<p class=\"has-text-align-center\"><em>V\u00eddeo da <em>mucosectomia assistida<\/em>\u00a0por\u00a0<em>banda el\u00e1stica<\/em><\/em><\/p>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-3 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-9-pos-resseccao-2.jpeg\" alt=\"\"\/><figcaption class=\"wp-element-caption\"><em>\u00c1rea de ressec\u00e7\u00e3o<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-10-endoclipe-2.jpeg\" alt=\"\"\/><figcaption class=\"wp-element-caption\"><em>Fechamento com endoclipe<\/em><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-11-2.jpeg\" alt=\"\"\/><figcaption class=\"wp-element-caption\"><em>Les\u00e3o ressecada<\/em><\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p>O anatomopatol\u00f3gico da pe\u00e7a confirma tratar-se de tumor neuroend\u00f3crino bem diferenciado (G2), com \u00edndice mit\u00f3tico 2M\/10 CGA, margens vertical (2 mm da les\u00e3o) e lateral livres, aus\u00eancia de invas\u00e3o perineural e angiolinf\u00e1tica, estadiamento patol\u00f3gico pT1a.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><a href=\"https:\/\/endoscopiaterapeutica.com.br\/wp-content\/uploads\/2024\/01\/Foto-12-anatomopatologico-1.jpeg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2024\/06\/Foto-12-anatomopatologico-1.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><em>Anatomopatol\u00f3gico<\/em><\/figcaption><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\" id=\"h-discussao\"><strong>Discuss\u00e3o<\/strong><\/h2>\n\n\n\n<p>A<strong> Gastrite Atr\u00f3fica Metapl\u00e1sica Autoimune (GAMA)<\/strong> \u00e9 um termo empregado para caracterizar uma variante de gastrite cr\u00f4nica, predominantemente observada no sexo feminino. Caracteriza-se pela agress\u00e3o imunomediada \u00e0s c\u00e9lulas parietais g\u00e1stricas, resultando na substitui\u00e7\u00e3o dessas c\u00e9lulas por tecido mucoso atr\u00f3fico e metapl\u00e1sico. A GAMA pode estar associada a outras doen\u00e7as autoimunes, sendo a tireoidite de Hashimoto e o diabetes mellitus tipo 1 as mais comumente observadas nesse contexto (<em><a href=\"https:\/\/endoscopiaterapeutica.com.br\/assuntosgerais\/gastrite-atrofica-guia-pratico-sobre-olga-e-olgim\/\" target=\"_blank\" rel=\"noreferrer noopener\">Clique aqui<\/a> para saber mais sobre Gastrite atr\u00f3fica e suas classifica\u00e7\u00f5es<\/em>).<\/p>\n\n\n\n<p>A destrui\u00e7\u00e3o das c\u00e9lulas parietais leva \u00e0 hipo\/acloridria, que estimula a hipergastrinemia como resposta fisiol\u00f3gica \u00e0 escassez de \u00e1cido clor\u00eddrico (HCl). O excesso de gastrina de forma cr\u00f4nica leva \u00e0 hipertrofia e hiperplasia das <strong>c\u00e9lulas enterocromafins-like (ECL), <\/strong>com a poss\u00edvel influ\u00eancia de fatores gen\u00e9ticos nesse fen\u00f4meno. Essas modifica\u00e7\u00f5es podem favorecer o surgimento de&nbsp;<strong>tumores neuroend\u00f3crinos g\u00e1stricos (carcinoides).<\/strong> A suspeita e o correto reconhecimento dessas les\u00f5es s\u00e3o fundamentais para evitar ressec\u00e7\u00f5es inadequadas (polipectomia convencional). A elegibilidade da modalidade terap\u00eautica empregada depende do tamanho da les\u00e3o, dos recursos dispon\u00edveis e da expertise do endoscopista.<\/p>\n\n\n\n<p><br>Os tumores do tipo 2 apresentam um comportamento semelhante ao observado nos tumores do tipo 1. Geralmente, s\u00e3o multifocais e apresentam um comportamento predominantemente indolente. Podem estar associados \u00e0 <a href=\"https:\/\/endoscopiaterapeutica.com.br\/assuntosgerais\/tumores-neuroendocrinos-do-pancreas\/\">s\u00edndrome neuroend\u00f3crina m\u00faltipla<\/a> (NEM tipo 1) e \u00e0 s\u00edndrome de Zollinger-Ellison. No caso de tumores neuroend\u00f3crinos g\u00e1stricos tipo 1 e 2 com di\u00e2metro inferior a 2 cm, a ressec\u00e7\u00e3o endosc\u00f3pica emerge como a terapia apropriada, atrav\u00e9s das t\u00e9cnicas de mucosectomia ou dissec\u00e7\u00e3o submucosa (ESD), a menos que existam fatores de mau progn\u00f3stico que indiquem o tratamento cir\u00fargico <em>(<a href=\"https:\/\/endoscopiaterapeutica.com.br\/assuntosgerais\/tumor-neuroendocrino-gastrico\/\">Clique aqui<\/a> para mais detalhes sobre tipos e graus de tumores neuroend\u00f3crinos).<\/em><\/p>\n\n\n\n<p>A vigil\u00e2ncia endosc\u00f3pica subsequente \u00e9 necess\u00e1ria a cada 6 a 12 meses, uma vez que esses pacientes continuam a manifestar altera\u00e7\u00f5es na mucosa pela hiperplasia de c\u00e9lulas enterocromafins-like (ECL), resultante da exposi\u00e7\u00e3o prolongada \u00e0 hipergastrinemia secund\u00e1ria \u00e0 doen\u00e7a de base.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-referencias\"><strong>Refer\u00eancias:<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>JENSEN, P.J.; FELDMAN, M.&nbsp;Metaplastic (chronic) atrophic gastritis. Uptodate (https:\/\/www.uptodate.com\/), 2023.&nbsp;<\/li>\n\n\n\n<li>Park, Jason Y et al. \u201cReview of autoimmune metaplastic atrophic gastritis.<strong>\u201d<\/strong>&nbsp;Gastrointestinal endoscopy&nbsp;vol. 77,2 (2013): j.gie.<\/li>\n\n\n\n<li>Jonathan R Strosberg, MD, Alexandra Gangi, MD Staging, treatment, and post-treatment surveillance of non-metastatic, well-differentiated gastrointestinal tract neuroendocrine (carcinoid) tumors. Uptodate (https:\/\/www.uptodate.com\/), 2023.&nbsp;<\/li>\n\n\n\n<li>Roberto GA, Rodrigues CMB, Peixoto RD, Younes RN.&nbsp;Gastric neuroendocrine tumor: A practical literature review.&nbsp;World J Gastrointest Oncol&nbsp;2020;&nbsp;12(8): wjgo.v12.i8.850.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Paciente do sexo feminino, 61 anos, natural e residente em Macei\u00f3 \u2013 AL, apresenta&hellip;<\/p>\n","protected":false},"author":5668,"featured_media":18262,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[742],"tipo":[153],"volume":[263],"class_list":["post-18261","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-742","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Diagn\u00f3stico e tratamento de tumor neuroend\u00f3crino g\u00e1strico na gastrite atr\u00f3fica metapl\u00e1sica autoimune &#8226; 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