Grade 1, 2, and 3 Multifocal Type 1 Gastric Neuroendocrine Tumor In The Same Patient, Case Report.

Objective: Gastric neuroendocrine tumors (GNETs) are a rare but increasingly recognized subset of neuroendocrine tumors, primarily due to advancements in diagnostic techniques. These tumors exhibit varied clinical presentations and prognoses, necessitating precise histopathological classification for appropriate management. GNETs are classified into four types, with Type 1 being the most common and often associated with autoimmune atrophic gastritis. Case: This case report presents a 41-year-old male diagnosed with multifocal, grade 2 GNET, initially misclassified as grade 3 at an external facility. Despite the usual indolent nature of Type 1 GNETs, total gastrectomy and D1-D2 lymph node dissection were performed due to the multifocal nature of the tumors and positive margins from previous resections. Immunohistochemical analysis confirmed the diagnosis, with a Ki-67 index of <1%. Despite initial aggressive histological features, the patient showed no recurrence at the 5-month follow-up. Conclusion: This case highlights the challenges in grading and managing GNETs, emphasizing the importance of multidisciplinary approaches and careful pathological examination to guide treatment.