regarding our case report describing a 54-year-old woman with multiple gastric carcinoid tumors arising in the setting of achlorhydria, hypergastrinemia, and hypertrophic gastric rugae with hypertrophic but vacuolated parietal cells. 1 We believe that our case, along with a previously reported case, 2 represents the fourth distinctive setting in which gastric carcinoids arise. However, in their correspondence, Drs Waldum and Qvigstad suggest that our patient may have had a rare polypoid form of Me´ne´-trie`r disease, and wonder if our patient had hypoalbuminemia. Me´ne´-trie`r disease, also known as hyproteinemic hypertrophic gastropathy, is characterized by gastric rugal hypertrophy, protein-losing gastropathy, and hypochlorhydria. We agree that Me´ne´trie`r disease is an excellent diagnostic consideration in our case, given the presence of hypertrophic gastric folds, and achlorhydria. However, we believe that our case is not an example of Me´ne´trie`r disease for the following reasons: (1) our patient's preoperative serum albumin level was normal, at 4.4 g/dL. (2) Our patient showed no evidence of peripheral edema, which usually accompanies the hypoalbuminemia of Me´ne´trie`r disease. (3) The histopathology of the stomach in our case was somewhat different from that of Me´ne´trie`r disease. Me´ne´trie`r disease is typically characterized by marked elongation and cystic dilatation of the foveolar epithelium, with atrophy of oxyntic glands and replacement by mucus glands. In our case, the parietal cells, not the mucus cells, were hyperplastic and hypertrophic, and showed marked vacuolization.Therefore, although we believe that Me´ne´trie`r disease is an excellent diagnostic consideration in a patient with hypertrophic gastric folds (with other diagnostic considerations including Zollinger-Ellison syndrome, gastric lymphoma, signet ring cell carcinoma, and Helicobacter pylori gastritis), we do not believe that the constellation of clinical and pathologic findings in our patient reflects Me´ne´trie`r disease.
