Clinical aspects of ECL-cell abnormalities

ECL cell hyperplasia results from hypergastrinemia, and in man this occurs due to achlorhydria in atrophic gastritis (pernicious anemia [PA]) and gast rinoma (Zollinger-Ellison syndrome [ZES]). Progression to neoplasia, i.e., ECL cell carcinoids (usually small, multicentric and non-functional), occur s in some five to 10 percent of patients with PA where they remain gastrin- dependent and reversible by normalization of serum gastrin by antrectomy. E ven if untreated, the carcinoids are almost invariably benign and do not ca use death. In ZES, ECL cell hyperplasia is progressive due to hypergastrine mia. However, carcinoids develop only in the MEN-I subtype but pose no addi tional threat of malignancy. A conservative approach is recommended for sma ll multicentric carcinoids, and the tumors do not need removal. By contrast , single, large, non-gastrin-dependent carcinoids represent a different bio logical and clinical problem and are frequently malignant.