Synchronous Peripancreatic Lymph Node Gastrinoma and Gastric Neuroendocrine Tumor Type 2
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
A 34-year-old man was referred to our hospital with gastric polypoid lesions and biopsy-confirmed neuroendocrine tumor (NET). Computed tomography (CT) revealed a 3×3.5×8-cm retroperitoneal mass behind the pancreas, with multiple hepatic metastases. His serum gastrin level was elevated to 1,396 pg/mL. We performed a wedge resection of the stomach, a right hemi-hepatectomy, and a retroperitoneal mass excision. After careful review of the clinical, radiological, histopathological, and immunohistochemical findings, peripancreatic gastrinoma, and synchronous gastric NET were ultimately diagnosed. We reviewed a CT scan that had been performed 6 years previously after surgery for a duodenal perforation. There was no evidence of gastric or hepatic lesions, but the retroperitoneal mass was present at the same site. Had gastrinoma been detected earlier, our patient could have been cured using less invasive treatment. This case demonstrates how important it is to consider Zollinger-Ellison syndrome in patients with a recurrent or aggressive ulcer.
Abstract
A 34-year-old man was referred to our hospital with gastric polypoid lesions and biopsy-confirmed neuroendocrine tumor (NET). Computed tomography (CT) revealed a 3×3.5×8-cm retroperitoneal mass behind the pancreas, with multiple hepatic metastases. His serum gastrin level was elevated to 1,396 pg/mL. We performed a wedge resection of the stomach, a right hemi-hepatectomy, and a retroperitoneal mass excision. After careful review of the clinical, radiological, histopathological, and immunohistochemical findings, peripancreatic gastrinoma, and synchronous gastric NET were ultimately diagnosed. We reviewed a CT scan that had been performed 6 years previously after surgery for a duodenal perforation. There was no evidence of gastric or hepatic lesions, but the retroperitoneal mass was present at the same site. Had gastrinoma been detected earlier, our patient could have been cured using less invasive treatment. This case demonstrates how important it is to consider Zollinger-Ellison syndrome in patients with a recurrent or aggressive ulcer.
참고문헌 (20)
- Passaro E Jr, "The origin of sporadic gastrinomas within the gastrinoma triangle: a theory", Arch Surg, 133, pp.13~16 (1998)
- Mian O, "Primary gastrinoma of lymph node: fact or fiction?", Am Surg, 75, pp.208~211 (2009)
- Norton JA, "Possible primary lymph node gastrinoma: occurrence, natural history, and predictive factors: a prospective study", Ann Surg, 237, pp.650~657 (2003)
- Anlauf M, "Primary lymph node gastrinoma or occult duodenal microgastrinoma with lymph node metastases in a MEN1 patient: the need for a systematic search for the primary tumor", Am J Surg Pathol, 32, pp.1101~1105 (2008)
- Herrmann ME, "Primary nodal gastrinomas", Arch Pathol Lab Med, 124, pp.832~835 (2000)
- Crosby DA, "Gastric neuroendocrine tumours", Dig Surg, 29, pp.331~348 (2012)
- Berna MJ, "A prospective study of gastric carcinoids and enterochromaffin-like cell changes in multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome: identification of risk factors", J Clin Endocrinol Metab, 93, pp.1582~1591 (2008)
- Norton JA, "Gastric carcinoid tumors in multiple endocrine neoplasia-1 patients with Zollinger-Ellison syndrome can be symptomatic, demonstrate aggressive growth, and require surgical treatment", Surgery, 136, pp.1267~1274 (2004)
- Jang SH, "Peripancreatic lymph node gastrinoma", Basic Appl Pathol, 2, pp.140~142 (2009)
- Howard TJ, "Gastrinoma excision for cure. A prospective analysis", Ann Surg, 211, pp.9~14 (1990)
- Zhou H, "Primary peripancreatic lymph node gastrinoma in a woman with MEN1", J Hepatobiliary Pancreat Surg, 13, pp.477~481 (2006)
- Strosberg J, "Survival and prognostic factor analysis of 146 metastatic neuroendocrine tumors of the mid-gut", Neuroendocrinology, 89, pp.471~476 (2009)
- Yu F, "Prospective study of the clinical course, prognostic factors, causes of death, and survival in patients with long-standing Zollinger-Ellison syndrome", J Clin Oncol, 17, pp.615~630 (1999)
- Cadiot G, "Prognostic factors in patients with Zollinger-Ellison syndrome and multiple endocrine neoplasia type 1. Groupe d’Etude des Neoplasies Endocriniennes Multiples (GENEM and groupe de Recherche et d’Etude du Syndrome de Zollinger-Ellison (GRESZE)", Gastroenterology, 116, pp.286~293 (1999)
- Jensen RT, "Gastrinoma(duodenal and pancreatic)", Neuroendocrinology, 84, pp.173~182 (2006)
- Bartlett EK, "Surgery for metastatic neuroendocrine tumors with occult primaries", J Surg Res, 184, pp.221~227 (2013)
- Capurso G, "Systematic review of resection of primary midgut carcinoid tumour in patients with unresectable liver metastases", Br J Surg, 99, pp.1480~1486 (2012)
- Givi B, "Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival", Surgery, 140, pp.891~897 (2006)
- Touzios JG, "Neuroendocrine hepatic metastases:does aggressive management improve survival?", Ann Surg, 241, pp.776~783 (2005)
- Norton JA, "Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors", Arch Surg, 138, pp.859~866 (2003)