Objective: We report a case of gastric neuroendocrine tumor with peculiar clinical-radiological pulmonary mani¬festations with an aggressive clinical course and fatal outcome. Case Report: Female patient, 28 years of age who began presenting the disease with dry cough and progressive dyspnea a month ago when making mild to moderate efforts. Personal history of gastropathy since adolescence and onset of hyperinsulinism when the patient was 23 year-old. Physical exam: No palpable lymph nodes, sym¬metric and hypoextensible chest, palpable vocal vibrations with decreased breath sounds in both hemithorax and bibasilar fine crackles. Abdomen: soft, tenderness in the hypogastrium. Chest X-ray: predominantly right alveolar-interstitial infiltrate. Double contrast CT thoraco-abdomino-pelvic: ground glass pattern distribution and multiple nodules with diffuse septal thickening that involved both lungs. Abdomen: uniform thickening of the stomach walls with multiple hypodense images in the celiac axis and pre aortic and gastrohepatic ligaments. Upper gastrointestinal endoscopy: thickened and infiltrated wall of the fundus and body area, probably because of malignant neoplasy. A biopsy was taken. Videofibrobronchoscopy: a transbronchial biopsy of the medial seg¬ment of the right lower lobe was performed. The histopathological studies of both biopsies disclosed the presence of a neuroendocrine tumor. Conclusions: This case presents an atypical and aggressive clinical course of a gastric neuroendocrine tumor in a 28-year-old patient who died. She started with respiratory clinical manifestations. The imagen studies disclosed metastases in both lungs that could be differentiated from a pulmonary neuroendocrine tumor. The importance of immunohistochemistry for diagnosis is underlined.