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Liu YG, Jiang ST, Zhou Y, Zhang JW, Sang XT, Zhang L, Lu X, Xu YY. Primary gastrinoma of the gallbladder: a case report and review of the literature. Front Oncol 2024; 13:1279766. [PMID: 38357423 PMCID: PMC10864482 DOI: 10.3389/fonc.2023.1279766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024] Open
Abstract
Background Primary gallbladder gastrinoma is an exceptionally uncommon tumor and is a rare form of neuroendocrine neoplasm. Until now, no cases of primary gallbladder gastrinoma and rare cases of primary gastrinoma from the biliary system have been reported. Case presentation We report a case of a 50-year-old woman with watery diarrhea who intermittently received proton pump inhibitors (PPIs) as treatment. A serum gastrin level of 711 pg/ml was recorded after the withdrawal of PPI over 1 week. Enhanced computed tomography (CT) imaging and octreotide imaging uncovered a solitary tumor at the hepatic hilar region. During the laparoscopic surgery, it was determined that the tumor had its origin in the wall of the gallbladder neck, prompting the implementation of a laparoscopic cholecystectomy. Histological analysis revealed a primary neuroendocrine tumor from the neck of the gallbladder. The patient's symptoms disappeared after the surgery with a follow-up of 6 months. Conclusions This case confirmed that primary gallbladder gastrinoma represents a distinct nosological entity. Immunohistochemical analysis plays a pivotal role in the diagnostic process. Given the limited understanding of primary gallbladder gastrinoma, our objective is to offer novel insights into this rare disease by delivering distinctive information and highlighting the therapeutic significance of surgical intervention.
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Affiliation(s)
- Yao-Ge Liu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Shi-Tao Jiang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yang Zhou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Jun-Wei Zhang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xin-Ting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Lei Zhang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Yi-Yao Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
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Pratap T, Jalal MJA, Jacob D, Mahadevan P, Nair SS, Raja S. Radiological Features of Zollinger–Ellison Syndrome: A Report of Two Cases. Indian J Radiol Imaging 2022; 32:395-402. [PMID: 36177273 PMCID: PMC9514913 DOI: 10.1055/s-0042-1750725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hypersecretion of gastrin from duodenal or pancreatic gastrinomas results in a rare clinical entity called Zollinger–Ellison syndrome (ZES). It mostly presents with abdominal pain and diarrhea. ZES may be sporadic or occur in association with multiple endocrine neoplasia type 1. Usually, ZES manifests between 20 and 50 years. We report two cases of patients who presented with abdominal pain, vomiting, watery diarrhea, and significant weight loss.
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Affiliation(s)
- Thara Pratap
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | | | - Dhanya Jacob
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Pushpa Mahadevan
- Department of Pathology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Seethal S. Nair
- Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Senthil Raja
- Department of Nuclear Medicine, VPS Lakeshore Hospital, Kochi, Kerala, India
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Cavalcanti E, Stasi E, Coletta S, Lorusso D, Rinaldi CM, Armentano R. Primary lymph node gastrinoma: a case report and review of the literature. World J Surg Oncol 2020; 18:80. [PMID: 32345299 PMCID: PMC7189517 DOI: 10.1186/s12957-020-01860-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background Gastrinoma is a rare form of neuroendocrine neoplasm. The presence of a primary lymph node localization of gastrinoma is a much debated and controversial topic in the literature, as regards whether these cases represent metastatic disease from an as yet unidentified primary tumor, or the de novo occurrence of a gastrinoma in a lymph node. Case presentation We report the case of a 24-year-old male with intense epigastric pain treated at the beginning with high dose proton pump inhibitors. Further workup with CT and subsequent laparotomy revealed a single peripancreatic lymph node. Histological examination highlighted a well-differentiated neuroendocrine tumor. Conclusion This case underlines that the primitive lymph node gastrinoma is a distinct nosological entity with a precise location in the context of rare neuroendocrine tumors that should be considered when specific symptoms are associated with the identification of isolated lymph nodes, after excluding any possible primitive locations of neoplastic localization.
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Affiliation(s)
- Elisabetta Cavalcanti
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy.
| | - Elisa Stasi
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy
| | - Sergio Coletta
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy
| | - Dionigi Lorusso
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy
| | - Caterina Mammone Rinaldi
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy
| | - Raffaele Armentano
- National Institute of Gastroenterology "S. de Bellis", Research Hospital Castellana Grotte Bari, Via Turi 27, 70013 Castellana Grotte (Ba), Bari, Italy
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Shao QQ, Zhao BB, Dong LB, Cao HT, Wang WB. Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies. World J Gastroenterol 2019; 25:4673-4681. [PMID: 31528093 PMCID: PMC6718045 DOI: 10.3748/wjg.v25.i32.4673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023] Open
Abstract
Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease. Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors, but surgical management to control gastrinoma itself remains controversial. Based on a thorough literature review, we design a surgical algorithm for ZES and list some significant consensus findings and recommendations: (1) For sporadic ZES, surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings. The surgical approach for sporadic ZES depends on the lesion location (including the duodenum, pancreas, lymph nodes, hepatobiliary tract, stomach, and some extremely rare sites such as the ovaries, heart, omentum, and jejunum). Intraoperative liver exploration and lymphadenectomy should be routinely performed; (2) For multiple endocrine neoplasia type 1-related ZES (MEN1/ZES), surgery should not be performed routinely except for lesions > 2 cm. An attempt to perform radical resection (pancreaticoduodenectomy followed by lymphadenectomy) can be made. The ameliorating effect of parathyroid surgery should be considered, and parathyroidectomy should be performed first before any abdominal surgery for ZES; and (3) For hepatic metastatic disease, hepatic resection should be routinely performed. Currently, liver transplantation is still considered an investigational therapeutic approach for ZES. Well-designed prospective studies are desperately needed to further verify and modify the current considerations.
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Affiliation(s)
- Qian-Qian Shao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Bang-Bo Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Liang-Bo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Hong-Tao Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
| | - Wei-Bin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China
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Abstract
This article reviews the role of surgical and medical management in patients with Zollinger-Ellison syndrome (ZES) due to a gastrin-secreting neuroendocrine tumor (gastrinoma). It concentrates on the status at present but also briefly reviews the changes over time in treatment approaches. Generally, surgical and medical therapy are complementary today; however, in some cases, such as patients with ZES and multiple endocrine neoplasia type 1, the treatment approach remains controversial.
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Affiliation(s)
- Jeffrey A Norton
- Department of Surgery, Stanford University School of Medicine, 291 campus Drive, Stanford, CA 94305-5101, USA
| | - Deshka S Foster
- Department of Surgery, Stanford University School of Medicine, 291 campus Drive, Stanford, CA 94305-5101, USA
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital, International University of Health and Welfare, 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, National Institutes of Health, Building 10, Room 9C-103, Bethesda, MD 20892-1804, USA.
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6
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Metz DC, Cadiot G, Poitras P, Ito T, Jensen RT. Diagnosis of Zollinger-Ellison syndrome in the era of PPIs, faulty gastrin assays, sensitive imaging and limited access to acid secretory testing. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017; 4:167-185. [PMID: 29326808 DOI: 10.2217/ije-2017-0018] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years the diagnosis of Zollinger-Ellison syndrome (ZES) has become increasingly controversial with several new approaches and criteria proposed, differing from the classical biochemical criterion of inappropriate hypergastrinemia (i.e., hypergastrinemia in the presence of hyperchlorhydria) (Table 1). These changes have come about because of the difficulty and potential dangers of stopping proton pump inhibitors (PPIs) for gastric acid analysis; the recognition than many of the current assays used to assess gastrin concentrations are unreliable; the development of sensitive imaging modalities that detect neuroendocrine tumors (NETs) including an increasing number of the primary gastrinomas; the increased use of percutaneous or endoscopic ultrasound (EUS)-directed biopsies/cytology and the general lack of availability of acid secretory testing. In this article we will discuss the basis for these controversies, review the proposed changes in diagnostic approaches and make recommendations for supporting the diagnosis of ZES in the modern era.
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Affiliation(s)
- David C Metz
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, PA, 19104, USA
| | - Guillaume Cadiot
- Service d"Hepato-Gastroenterologie, Centre Hospitalier Universitaire de Reims, Hopital Robert Debre, F-51092, Reims, France
| | - Pierre Poitras
- Department of Gastroenterology, CHUM, Université de Montréal, Montreal, Canada
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital, International University of Health and Welfare 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, Maryland, 20817, USA
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Abu Ghanimeh M, Abuamr K, Sadeddin E, Yousef O. Severe chronic diarrhoea secondary to primary lymph node gastrinoma. BMJ Case Rep 2017; 2017:bcr-2016-216855. [PMID: 28446479 PMCID: PMC5534825 DOI: 10.1136/bcr-2016-216855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/03/2022] Open
Abstract
The existence of primary lymph node (LN) gastrinoma is questionable and controversial. In fact, the presence of gastrinoma in such uncommon site raises the possibility of metastasis from another occult primary site. An extensive evaluation and careful follow-up is always warranted. A female aged 48 years presented with chronic abdominal pain and watery diarrhoea. Her serum gastrin and chromogranin were elevated, and an underlying gastrinoma was suspected. Further evaluation with an octreotide scan, an endoscopic ultrasound and a secretin stimulation test confirmed the diagnosis. Further evaluation for multiple endocrine neoplasia-1 syndrome was negative. She underwent a surgical enucleation near the head of the pancreas. No other lesions were found after careful exploration of the gastrinoma triangle. Histology showed a LN with a neuroendocrine tumour that tested positively with gastrin and chromogranin stains. Her symptoms resolved postoperatively, her serum gastrin normalised and a repeated octreotide scan was negative.
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Affiliation(s)
- Mouhanna Abu Ghanimeh
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Khalil Abuamr
- Gastroenterology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Esmat Sadeddin
- Gastroenterology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Osama Yousef
- Gastroenterology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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Nath AL, Saxena NA, Kulkarni BK, Borwankar SS, Lahoti HN, Oak SN. Zollinger-Ellison Syndrome in a 12-year-old Child. J Indian Assoc Pediatr Surg 2017; 22:168-169. [PMID: 28694576 PMCID: PMC5473305 DOI: 10.4103/0971-9261.207623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The syndrome described by Zollinger and Ellison in 1955 is a rare clinical entity which is even rarer in children. This report describes a 12-year-old boy who presented with refractory peptic ulcer disease which was finally diagnosed to be due to a gastrinoma and was successfully treated.
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Affiliation(s)
- Abir Lal Nath
- Department of Pediatrics, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Nandita A Saxena
- Department of Pediatric Surgery, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Bharati K Kulkarni
- Department of Pediatric Surgery, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Shyam S Borwankar
- Department of Pediatric Surgery, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Hemant N Lahoti
- Department of Pediatric Surgery, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
| | - Sanjay N Oak
- Department of Pediatric Surgery, Dr. D. Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India
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Murakami T, Usui T, Nakamoto Y, Nakajima A, Mochida Y, Saito S, Shibayama T, Yamazaki N, Hatoko T, Kato T, Yonemitsu S, Muro S, Oki S. Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1. Intern Med 2017; 56:1375-1381. [PMID: 28566601 PMCID: PMC5498202 DOI: 10.2169/internalmedicine.56.7230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 53-year-old woman developed end-stage renal failure during a 15-year clinical course of primary hyperparathyroidism and was referred to our hospital for evaluation of suspected multiple endocrine neoplasia type 1 (MEN1). Genetic testing revealed a novel deletion mutation at codon 467 in exon 10 of the MEN1 gene. Systemic and selective arterial calcium injection (SACI) testing revealed hyperglucagonemia and hypergastrinemia with positive gastrin responses. A pathological examination revealed glucagonoma and a lymph node gastrinoma. The findings in this case indicate the importance of early diagnosis of MEN1 and demonstrate the utility of systemic and SACI testing in renal failure cases.
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Affiliation(s)
- Takaaki Murakami
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
| | - Takeshi Usui
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Akio Nakajima
- Department of Surgery, Osaka Red Cross Hospital, Japan
| | - Yuki Mochida
- Department of Surgery, Osaka Red Cross Hospital, Japan
| | - Sumio Saito
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Japan
| | | | | | - Tomonobu Hatoko
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
| | - Tomoko Kato
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
| | - Shin Yonemitsu
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
| | - Seiji Muro
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
| | - Shogo Oki
- Department of Diabetes and Endocrinology, Osaka Red Cross Hospital, Japan
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