Answer: Multiple carcinoid tumors

Histology: The multiple distinct nodules were identified and all were composed of nests of uniform cells with “salt and pepper” nuclei.

Discussion: Patients with autoimmune gastritis can develop multiple carcinoid tumors of the stomach. In autoimmune gastritis, the patients develop auto antibodies to parietal cells. This results in the loss of acid production and in the loss of intrinsic factor. The loss of intrinsic factor can lead to the development of pernicious anemia. The loss of acid production can result in excess gastrin production which in turn will stimulate gastric endocrine cells eventually producing multiple carcinoid tumors in the setting of autoimmune gastritis.