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Ranaldi R, Lorenzini I, Montesi A, Bearzi I. Multiple Gastric Carcinoids and Pernicious Anemia: Report of a Case. TUMORI JOURNAL 2018; 72:439-45. [PMID: 3765125 DOI: 10.1177/030089168607200417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of pernicious anemia associated with multiple gastric carcinoids is reported. The neoplastic growth was composed of enterochromaffin-like (ECL) cells, and ECL cell hyperplasia was observed also in hyperplastic polyps, inside the fundic glands and in small nests lying in the lamina propria (microcarcinoidosis). The possible relation between pernicious anemia and ECL cell hyperplasia is discussed.
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2
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Veniaminova NA, Hayes MM, Varney JM, Merchant JL. Conditional deletion of menin results in antral G cell hyperplasia and hypergastrinemia. Am J Physiol Gastrointest Liver Physiol 2012; 303:G752-64. [PMID: 22766853 PMCID: PMC3468536 DOI: 10.1152/ajpgi.00109.2012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Antral gastrin is the hormone known to stimulate acid secretion and proliferation of the gastric corpus epithelium. Patients with mutations in the multiple endocrine neoplasia type 1 (MEN1) locus, which encodes the protein menin, develop pituitary hyperplasia, insulinomas, and gastrinomas in the duodenum. We previously hypothesized that loss of menin leads to derepression of the gastrin gene and hypergastrinemia. Indeed, we show that menin represses JunD induction of gastrin in vitro. Therefore, we examined whether conditional deletion of Men1 (Villin-Cre and Lgr5-EGFP-IRES-CreERT2), with subsequent loss of menin from the gastrointestinal epithelium, increases gastrin expression. We found that epithelium-specific deletion of Men1 using Villin-Cre increased plasma gastrin, antral G cell numbers, and gastrin expression in the antrum, but not the duodenum. Moreover, the mice were hypochlorhydric by 12 mo of age, and gastric somatostatin mRNA levels were reduced. However, duodenal mRNA levels of the cyclin-dependent kinase inhibitor p27(Kip1) were decreased, and cell proliferation determined by Ki67 staining was increased. About 11% of the menin-deficient mice developed antral tumors that were negative for gastrin; however, gastrinomas were not observed, even at 12 mo of age. No gastrinomas were observed with conditional deletion of Men1 in the Lgr5 stem cells 5 mo after Cre induction. In summary, epithelium-specific deletion of the Men1 locus resulted in hypergastrinemia due to antral G cell hyperplasia and a hyperproliferative epithelium, but no gastrinomas. This result suggests that additional mutations in gene targets other than the Men1 locus are required to produce gastrin-secreting tumors.
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Affiliation(s)
- Natalia A. Veniaminova
- 1Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Michael M. Hayes
- 1Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Jessica M. Varney
- 1Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Juanita L. Merchant
- 1Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; and ,2Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
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3
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Abstract
Nonneoplastic and neoplastic proliferative lesions of endocrine cells of the gastrointestinal tract are detailed. A multistep continuum from hyperplasia, dysplasia to neoplasia is identified for histamine-producing enterochromaffin-like (ECL) cells of the gastric corpus. Most gastric neuroendocrine tumors (NETs) are silent and composed by ECL cells, the second most frequent neuroendocrine neoplasms being the high-grade neuroendocrine carcinoma (NEC). In the duodenum, preneoplastic lesions are similarly described for gastrin (G) and somatostatin (D) cells. G-cell NETs are the most frequent neuroendocrine tumors of the duodenum, either functioning or nonfunctioning, followed by D-cell NETs and gangliocytic paraganglioma (GCP). No systematic definition of nonneoplastic lesions exists for endocrine cells of the ileum, appendix, and colon-rectum. The most frequent ileal NETs are serotonin-producing enterochromaffin (EC)-cell NETs (classic carcinoid), associating with functional syndrome only in presence of liver metastases. Neoplasms are usually larger in the colon as compared with the small lesions observed in the rectum. High-grade NECs are observed in the colon and rectum-sigmoid, often associate with nonendocrine neoplastic components, and fare an aggressive course with poor outcome and short survival.
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Affiliation(s)
- Guido Rindi
- Institute of Anatomic Pathology, Università Cattolica del Sacro Cuore - Policlinico A. Gemelli, Largo A. Gemelli, 8, Rome I-00168, Italy.
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Abstract
Gastrinomas are defined as gastrin producing tumors that are associated with an elevated fasting gastrin serum level, a positive gastrin secretin stimulation test and certain clinical symptoms, e.g. recurrent peptic ulcer disease and occasionally diarrhea, the so-called Zollinger-Ellison syndrome. Most gastrinomas occur in the duodenum (approx. 70%) and not in the pancreas. The duodenal gastrinomas are small, and when they occur in association with the genetic syndrome of multiple endocrine neoplasia type 1 (MEN1), they are multicentric and originate from precursor lesions. The prognosis of duodenal gastrinomas is better than that of pancreatic gastrinomas, since despite early lymph node metastasis they progress slowly to liver metastasis.
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Affiliation(s)
- Günter Klöppel
- Department of Pathology, University of Kiel, Kiel, Germany.
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5
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Endocrine hyperplasia and dysplasia in the pathogenesis of gastrointestinal and pancreatic endocrine tumors. Gastroenterol Clin North Am 2007; 36:851-65, vi. [PMID: 17996794 DOI: 10.1016/j.gtc.2007.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Non-neoplastic proliferative lesions of endocrine cells have been described throughout the gastrointestinal tract and pancreas. A multistep continuum from hyperplasia and dysplasia to neoplasia originally was identified and systematically defined for histamine-producing enterochromaffin-like (ECL) cells of the gastric corpus. More recently, a similar classification system was devised for gastrin (G)- and somatostatin (D)-producing cells in the duodenum. Preneoplastic lesions of the endocrine pancreas still lack a solid and widely accepted definition of a multistep growth process. Similarly, in spite of reports of carcinoid-associated endocrine cell hyperplasia, there is no systematic definition of nonneoplastic lesions of the endocrine cells of the ileum, appendix and colorectum.
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6
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Berna MJ, Hoffmann KM, Long SH, Serrano J, Gibril F, Jensen RT. Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features. Medicine (Baltimore) 2006; 85:331-364. [PMID: 17108779 PMCID: PMC9817094 DOI: 10.1097/md.0b013e31802b518c] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In two-thirds of patients with Zollinger-Ellison syndrome (ZES), fasting serum gastrin (FSG) levels overlap with values seen in other conditions. In these patients, gastrin provocative tests are needed to establish the diagnosis of ZES. Whereas numerous gastrin provocative tests have been proposed, only the secretin, calcium, and meal tests are widely used today. Many studies have analyzed gastrin provocative test results in ZES, but they are limited by small patient numbers and methodologic differences. To address this issue, we report the results of a prospective National Institutes of Health (NIH) study of gastrin provocative tests in 293 patients with ZES and compare these data with those from 537 ZES and 462 non-ZES patients from the literature. In 97%-99% of gastrinoma patients, an increase in serum gastrin post secretin (Delta secretin) or post calcium (Delta calcium) occurred. In NIH ZES patients with <10-fold increase in FSG, the sensitivity/specificity of the widely used criteria were as follows: Delta secretin > or =200 pg/mL (83%/100%), Delta secretin >50% (86%/93%), Delta calcium > or =395 pg/mL (54%/100%), and Delta calcium >50% (78%/83%). A systematic analysis of the sensitivity and specificity of other possible criteria for a positive secretin or calcium test allowed us to identify a new criterion for secretin testing (Delta > or =120 pg/mL) with the highest sensitivity/specificity (94%/100%) and to confirm the commonly used criterion for calcium tests (Delta > or =395 pg/mL) (62%/100%). This analysis further showed that the secretin test was more sensitive than the calcium test (94% vs. 62%). Our results suggest that secretin stimulation should be used as the first-line provocative test because of its greater sensitivity and simplicity and lack of side effects. In ZES patients with a negative secretin test, 38%-50% have a positive calcium test. Therefore the calcium test should be considered in patients with a strong clinical suspicion of ZES but a negative secretin test. Furthermore, we found that some clinical (diarrhea, duration of medical treatment), laboratory (basal acid output), and tumoral (size, extent) characteristics correlate with the serum gastrin increase post secretin and post calcium. However, using the proposed criteria, the result of these provocative tests (that is, positive or negative) is minimally influenced by these factors, so secretin and calcium provocative tests are reliable in patients with different clinical, laboratory, and tumor characteristics. A systematic analysis of meal testing showed that 54%-77% of ZES patients have a <50% postprandial serum gastrin increase. However, 9%-20% of ZES patients had a >100% increase post meal, causing significant overlap with antral syndromes. Furthermore, we could not confirm the usefulness of meal tests for localization of duodenal gastrinomas. We conclude that the secretin test is a crucial element in the diagnosis of most ZES patients, the calcium test may be useful in selected patients, but the meal test is not helpful in the management of ZES. For secretin testing, the criterion with the highest sensitivity and specificity is an increase of > or =120 pg/mL, which should replace other criteria commonly used today.
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Affiliation(s)
- Marc J Berna
- From Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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7
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Berna MJ, Hoffmann KM, Serrano J, Gibril F, Jensen RT. Serum gastrin in Zollinger-Ellison syndrome: I. Prospective study of fasting serum gastrin in 309 patients from the National Institutes of Health and comparison with 2229 cases from the literature. Medicine (Baltimore) 2006; 85:295-330. [PMID: 17108778 PMCID: PMC9806863 DOI: 10.1097/01.md.0000236956.74128.76] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The assessment of fasting serum gastrin (FSG) is essential for the diagnosis and management of patients with the Zollinger-Ellison syndrome (ZES). Although many studies have analyzed FSG levels in patients with gastrinoma, limited information has resulted from these studies because of their small size, different methodologies, and lack of correlations of FSG levels with clinical, laboratory, or tumor features in ZES patients. To address this issue, we report the results of a prospective National Institutes of Health (NIH) study of 309 patients with ZES and compare our results with those of 2229 ZES patients in 513 small series and case reports in the literature. In the NIH and literature ZES patients, normal FSG values were uncommon (0.3%-3%), as were very high FSG levels >100-fold normal (4.9%-9%). Two-thirds of gastrinoma patients had FSG values <10-fold normal that overlap with gastrin levels seen in more common conditions, like Helicobacter pylori infection or antral G-cell hyperplasia/hyperfunction. In these patients, FSG levels are not diagnostic of ZES, and gastrin provocative tests are needed to establish the diagnosis. Most clinical variables (multiple endocrine neoplasia type 1 status, presence or absence of the most common symptoms, prior medical treatment) are not correlated with FSG levels, while a good correlation of FSG values was found with other clinical features (prior gastric surgery, diarrhea, duration from onset to diagnosis). Increasing basal acid output, but not maximal acid output correlated closely with increasing FSG. Numerous tumoral features correlated with the magnitude of FSG in our study, including tumor location (pancreatic > duodenal), primary size (larger > smaller) and extent (liver metastases > local disease). In conclusion, this detailed analysis of FSG in a large number of patients with ZES allowed us to identify important clinical guidelines that should contribute to improved diagnosis and management of patients with ZES.
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Affiliation(s)
- Marc J Berna
- From Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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8
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Anlauf M, Garbrecht N, Henopp T, Schmitt A, Schlenger R, Raffel A, Krausch M, Gimm O, Eisenberger CF, Knoefel WT, Dralle H, Komminoth P, Heitz PU, Perren A, Klöppel G. Sporadic versus hereditary gastrinomas of the duodenum and pancreas: Distinct clinico-pathological and epidemiological features. World J Gastroenterol 2006; 12:5440-6. [PMID: 17006979 PMCID: PMC4088224 DOI: 10.3748/wjg.v12.i34.5440] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrinomas are defined as gastrin secreting tumors that are associated with Zollinger-Ellison syndrome (ZES). ZES is characterized by elevated fasting gastrin serum levels, positive secretin stimulation test and clinical symptoms such as recurrent peptic ulcer disease, gastroesophageal reflux disease and occasional diarrhea. Genetically, nonhereditary (sporadic) gastrinomas are distinguished from hereditary gastrinomas, which are associated with multiple endocrine neoplasia type 1 (MEN1) syndrome. In general, duodenal gastrinomas are small and solitary if they are sporadic and multiple as well as hereditary. The sporadic gastrinomas occur in the duodenum or in the pancreas while the hereditary gastrinomas almost all occur in the duodenum. Our series of 77 sporadic duodenal neuroendocrine tumors (NETs) includes 18 patients (23.4%) with gastrinomas and ZES. Of 535 sporadic NETs in the pancreas collected from the NET archives of the departments of pathology in Zürich, Switzerland, and Kiel, Germany, 24 patients (4.5%) suffered from sporadic pancreatic gastrinomas and ZES. These NETs have to be distinguished from tumors with immunohistochemical positivity for gastrin but without evidence of ZES. An additional 19 patients suffered from MEN1 and ZES. These patients showed exclusively duodenal gastrinomas, but not pancreatic gastrinomas. The prognosis of sporadic and MEN1-associated duodenal gastrinomas is better than that of pancreatic gastrinomas, since they progress slowly to liver metastasis. In summary, sporadic and MEN1-associated gastrinomas in the duodenum and pancreas show different clinico-pathological and genetic features. The incidence of sporadic duodenal gastrin-producing tumors is increasing, possibly due to optimized diagnostic procedures. In contrast, pancreatic MEN1-associated gastrinomas seem to be extremely rare. A considerable subset of tumors with immunohistochemical expression of gastrin but without evidence of ZES should be designated as functionally inactive NETs expressing gastrin, but not as gastrinomas.
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Affiliation(s)
- Martin Anlauf
- Department of Pathology, University of Kiel, Michaelisstrasse 11, 24105 Kiel, Germany.
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9
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Takeno S, Noguchi T, Kubo N, Sato T, Uchida Y, Moriuchi A. Development of an inveterate gastroduodenal ulcer caused by antral G-cell hyperplasia of the stomach (pseudo-Zollinger-Ellison Syndrome): report of a case. Surg Today 2001; 30:923-7. [PMID: 11059735 DOI: 10.1007/s005950070047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe herein the case of a 54-year-old Japanese woman in whom an inveterate peptic ulcer developed in association with pseudo-Zollinger-Ellison Syndrome (pseudo-ZES). The patient presented with weight loss and abdominal distension caused by antral and duodenal stenosis due to an inveterate peptic ulcer. Her serum gastrin level was very high; however, no evidence of a gastrinoma or carcinoid tumor was detected by preoperative examinations or surgery. A total gastrectomy and double-tract reconstruction was performed, and pathological examination revealed a gastric ulcer (UL-IV) with no histopathological evidence of a neoplasm. Immunohistochemical staining showed an obvious increase in the number of endocrine cells that were positive for chromogranin A, and marked G-cell hyperplasia was observed in the antral mucosa. Furthermore, the number of enterochromaffin-like cells was remarkably high. From the results of the immunohistochemical examination, the patient was diagnosed as having hypergastrinemia due to antral G-cell hyperplasia. Postoperatively, the patient's serum gastrin level fell rapidly to within the normal range, her nutritional status improved, and her weight increased by about 10 kg within 1 year.
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Affiliation(s)
- S Takeno
- Department of Surgery II, Oita Medical University, Japan
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10
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Abstract
This paper aims at describing the neuroendocrine cell growths of the gastric mucosa and their pathogenesis. In the corpus-fundus mucosa, gastric neuroendocrine nontumor growths are mostly represented by hyperplastic and, more rarely, dysplastic enterochromaffin-like (ECL) cell changes, while hyperplasia of gastrin-producing (G) cells and, rarely, of somatostatin-producing (D) cells are reported in the antral mucosa. The large majority of gastric neuroendocrine tumors is made by benign, gastrin-dependent, well-differentiated ECL cell growths arising in a background of chronic atrophic gastritis (type I) or, more rarely, associated with type I multiple endocrine neoplasia (MEN I) and Zollinger-Ellison (ZE) syndromes (type II). Rare, aggressive, frequently metastatic, well-differentiated gastric neuroendocrine tumors are gastrin-independent and arise as sporadic lesions in the absence of specific gastric pathology (type III). Poorly differentiated neuroendocrine carcinomas (PDEC) are rare, highly aggressive carcinomas. A central role for gastrin is postulated in the pathogenesis of well-differentiated type I and II ECL cell tumors with different possible genetic mechanisms. A more complex genetic background, independent of gastrin and possibly implicating altered function or mutation of p53 and other genes is highly suspected for the development of aggressive type III ECL cell carcinomas and PDECs.
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Affiliation(s)
- E Solcia
- Surgical Pathology Unit, University of Pavia, Pavia, Italy
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12
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Affiliation(s)
- Yogeshwar Dayal
- Department of Pathology, New England Medical Center Hospital, 750 Washington St, 02111, Boston, MA
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Annibale B, De Magistris L, Corleto V, D'Ambra G, Marignani M, Iannoni C, Delle Fave G. Zollinger-Ellison syndrome and antral G-cell hyperfunction in patients with resistant duodenal ulcer disease. Aliment Pharmacol Ther 1994; 8:87-93. [PMID: 8186351 DOI: 10.1111/j.1365-2036.1994.tb00164.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We measured basal and pentagastrin-stimulated acid secretion, as well as basal and meal-stimulated plasma gastrin concentration to determine, in 67 patients affected by resistant duodenal ulcer, whether their condition could be related to gastric acid secretion and/or gastrin-related syndromes. We then compared them to 46 duodenal ulcer control patients. The outpatients were investigated consecutively. The resistant duodenal ulcer patients differed from the controls only in their higher complication rates (bleeding or perforation, P < 0.05). We identified five patients in the resistant duodenal ulcer group with Zollinger-Ellison syndrome and 12 with antral G cell hyperfunction, whereas in the control group only one patient was affected by antral G cell hyperfunction. IgG anti-Helicobacter pylori antibodies were positive for the presence of infection in 7 of the hypergastrinaemic patients. When Zollinger-Ellison syndrome or antral G cell hyperfunction were excluded, no differences could be found in gastric acid secretion, or basal and meal-stimulated plasma gastrin levels, between the resistant and control duodenal ulcer patients, except for basal acid hypersecretion (resistant duodenal ulcer 16% vs duodenal ulcer 2% P = 0.0144). In the presence of duodenal ulcer disease resistant to H2-blockers, it is mandatory to measure basal plasma gastrin concentration since it was possible to diagnose the gastrin-related syndromes, Zollinger-Ellison syndrome and antral G cell hyperfunction, in 26% of this group of patients.
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Affiliation(s)
- B Annibale
- Gastroenterology Unit, University La Sapienza, Rome, Italy
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14
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Osaka M, Aizawa K, Suzuki T, Soga J. A case of duodenal ulcer with antral gastrin cell hyperplasia. Med Mol Morphol 1993. [DOI: 10.1007/bf02348035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Park SM, Park HS. G- and D-cell populations, serum and tissue concentrations of gastrin and somatostatin in patients with peptic ulcer diseases. Korean J Intern Med 1993; 8:1-7. [PMID: 7903552 PMCID: PMC4532074 DOI: 10.3904/kjim.1993.8.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Gastric acid is the most important pathophysiologic determinant in the development of peptic ulcer diseases, and gastrin and somatostatin are believed to be physiologic hormonal regulators in gastric acid secretion. The aim of this study is to investigate patterns of these peptides, both in serum and in tissue, and to correlate with numbers of their secretory cells in the antral and the duodenal bulb mucosa. METHODS The study population was made up of 256 patients with peptic ulcer (duodenal ulcer, 127; gastric ulcer, 74) and 55 patients with non-ulcer control subjects. Serum and mucosal concentrations of G17, G34 and somatostatin were measured by radioimmunoassay technique and peptides producing cells were identified immunohistochemically using peroxidase-antiperoxidase staining technique. RESULTS Serum G17 concentration was significantly decreased in duodenal ulcer patients (93.4 +/- 36.0 pg/ml) and G34 were more than twice as high as G17 both in patients with gastric and duodenal ulcer (210.6 +/- 50.6 pg/ml and 202.7 +/- 48.1 pg/ml vs 103.8 +/- 41.8 pg/ml and 93.4 +/- 36.0 pg/ml). Antral G17 (19.9 +/- 14.8 mcg/g, tissue) and G34 (26.6 +/- 18.5 mcg/g, tissue) were increased in duodenal ulcer patients and duodenal G17 (12.5 +/- 9.5 mcg/g. tissue in Gu and 8.5 +/- 7.4 mcg/g. tissue in DU) and G34 (15.7 +/- 12.6 mcg/g. tissue in GU and 13.9 +/- 12.0 mcg/g. tissue in DU) concentrations were found to be increased in both gastric and duodenal ulcer patients than in non-ulcer subjects (G17: 5.3 +/- 4.9 mcg/g. tissue. G34: 6.5 +/- 4.4 mcg/g. tissue). Only the antral somatostatin concentration was significantly increased in duodenal ulcer patients (5.3 +/- 5.9 mcg/g. tissue). Numbers of the antral G- and D-cell were lowest in GU patients (48.1 +/- 47.4 and 7.9 +/- 12.3) and numbers of both cells decreased proportionately with the severity of atrophic gastritis and/or intestinal metaplasia of the gastric mucosa. D/G cell ratio between non-ulcer subjects and DU patients was similar (1:4 and 1:5) but slightly increased in GU patients (1:7). There was no correlation between numbers of each peptide-producing cells and serum or mucosal concentration of gastrin and somatostatin. CONCLUSIONS Patients with duodenal ulcer had decreased level of serum G17 in the fasting state while mucosal concentrations of G17 and G34 were increased in the antrum and the duodenal bulb. Patients with gastric ulcer had increased levels of G17 and G34 only in the duodenal bulb mucosa. Only the antral somatostatin concentration was significantly increased in duodenal ulcer patients. Patients with gastric ulcer had lowest numbers of G- and D-cells in the antrum and numbers of both cells decreased proportionately with the degree of chronic atrophic gastritis and/or intestinal metaplasia of the gastric antrum. Numbers of G- and D-cells were not correlated with the serum or mucosal concentrations of each peptide.
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Affiliation(s)
- S M Park
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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16
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Di Mario F, Plebani M, Gottardello L, Battaglia G, Vianello F, Farinati F, Del Favero G. Role of serum fasting gastrin in screening for hypergastrinemic syndromes in duodenal ulcer disease. Clin Biochem 1992; 25:121-4. [PMID: 1623579 DOI: 10.1016/0009-9120(92)80055-l] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Basal serum gastrin levels were measured in 237 patients with endoscopically confirmed duodenal ulcer and were higher than normal in 16 cases. Protein meal gastrin stimulation was performed on this group of 16 patients and on a control group of 48 patients with normal basal gastrin concentrations but high rates of either ulcer recurrence or of complications (e.g., bleeding or perforation); 21 patients from the two groups were also tested for serum gastrin inhibition with secretin. Four cases (25%) of antral G-cell hyperfunction were found in the first group, plus 1 case compatible with Zollinger-Ellison syndrome (6.2%). Only 1 case (2%) of antral G-cell hyperfunction was found among the 48 controls. These results suggest the clinical utility of routine basal gastrin measurement in screening for hypergastrinemic patients with duodenal ulcer disease.
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Affiliation(s)
- F Di Mario
- Department of Gastroenterology, University of Padua, Italy
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17
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Annibale B, Bonamico M, Rindi G, Villani L, Ferrante E, Vania A, Solcia E, Delle Fave G. Antral gastrin cell hyperfunction in children. A functional and immunocytochemical report. Gastroenterology 1991; 101:1547-51. [PMID: 1683324 DOI: 10.1016/0016-5085(91)90390-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antral gastrin cell hyperfunction is a rare condition, often associated with severe duodenal ulcer disease. In children, clinical and functional characteristics of this syndrome are poorly known. Two cases are described here: one child had melena and the other had moderate abdominal pain, both without peptic ulceration. Basal and postprandial increase of gastrin levels showed a response over the upper normal range, indicating gastrin cell hyperfunction. Acid hypersecretion, both basal and after pentagastrin stimulation, was also found in the two children, confirming the biological effect of their sustained hypergastrinemia. Gastrin cell counts were within the normal range, while the number of somatostatin D cells was significantly reduced. This report stresses the importance of diagnosing antral gastrin cell hyperfunction in children because this unrecognized condition may manifest with serious complications (bleeding) or nonspecific abdominal symptoms.
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Affiliation(s)
- B Annibale
- I Cattedra di Gastroenterologia, Università degli Studi La Sapienza, Rome, Italy
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18
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Jauregui HO, Kessimian N, McMillan PN, Nadra L. Lectin binding to glycoconjugates of the human gastric fundus. PROGRESS IN HISTOCHEMISTRY AND CYTOCHEMISTRY 1991; 24:1-56. [PMID: 1771234 DOI: 10.1016/s0079-6336(11)80035-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- H O Jauregui
- Department of Pathology, Rhode Island Hospital, Providence 02902
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20
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Schimke RN. Multiple endocrine neoplasia: how many syndromes? AMERICAN JOURNAL OF MEDICAL GENETICS 1990; 37:375-83. [PMID: 1979712 DOI: 10.1002/ajmg.1320370317] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The phrase multiple endocrine neoplasia (MEN) generally denotes an association of tumors so specific as to constitute a syndrome. Three well-recognized such syndromes exist. All are autosomal dominant traits and all have been tentatively mapped to specific chromosomes. Other purported endocrine tumor syndromes have been suggested either as new entities or as subtypes of the existing MEN syndromes. The evidence in favor of these contentions is examined critically. Only one "new" association, that of pheochromocytomas and islet cell tumors, seems reasonable, and even in this setting, some relatives have had manifestations of von Hippel-Lindau syndrome. There is no compelling reason why such conditions as von Hippel-Lindau syndrome, peripheral neurofibromatosis, McCune-Albright syndrome, and others should be reclassified as MEN syndromes, although awareness of their collective endocrine abnormalities is clinically important.
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Affiliation(s)
- R N Schimke
- Department of Medicine, Kansas University Medical School, Kansas City 66103
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Primrose JN, Naik KS, Blackett RL, King RF, Holmfield JH, Lagopolous M, Johnston D. Is antral gastrin important in the resistance of duodenal ulcers to H2 receptor antagonists or in recurrent ulceration after highly selective vagotomy? Gut 1990; 31:763-6. [PMID: 1973394 PMCID: PMC1378531 DOI: 10.1136/gut.31.7.763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Basal serum gastrin, integrated gastrin response to a meal, and integrated gastrin response to insulin induced hypoglycaemia were measured in 60 patients with duodenal ulcer before and after elective highly selective vagotomy to determine whether antral gastrin has a role in resistance to H2 receptor antagonist treatment which the patients had received before surgery or in the development of recurrent ulceration after vagotomy. The basal gastrin, integrated gastrin response to a meal, and the integrated gastrin response to insulin were similar in patients whose ulcers healed after H2 receptor agonist treatment or were refractory to at least three months of this treatment. The same parameters measured before or after highly selective vagotomy were similar in patients who eventually developed recurrent ulceration compared with those who did not. As expected the basal and meal stimulated (but not insulin stimulated) serum gastrin values increased after highly selective vagotomy. Ulcer patients with particularly high gastrin values (whether basal or stimulated) were not more resistant to H2 receptor antagonist treatment or prone to develop ulcer recurrence after highly selective vagotomy. This study suggests that antral gastrin is not important in 'resistance' of duodenal ulceration either to H2 receptor antagonist treatment or to highly selective vagotomy.
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Affiliation(s)
- J N Primrose
- University Department of Surgery, General Infirmary, Leeds
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Frucht H, Howard JM, Stark HA, McCarthy DM, Maton PN, Gardner JD, Jensen RT. Prospective study of the standard meal provocative test in Zollinger-Ellison syndrome. Am J Med 1989; 87:528-36. [PMID: 2573280 DOI: 10.1016/s0002-9343(89)80609-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this work was to evaluate the proposed usefulness of a standard meal-stimulated gastrin provocative test in: (1) distinguishing Zollinger-Ellison syndrome (ZES) from antral syndromes; (2) localizing duodenal gastrinomas; or (3) suggesting that patients with multiple endocrine neoplasia type I (MEN-I) may have an increased incidence of antral syndromes. PATIENTS AND METHODS Seventy-four consecutive patients with ZES referred to the National Institutes of Health were studied prospectively. The extent and location of gastrinomas, acid secretory studies, and the presence or absence of MEN-I were determined and correlated with the results of the gastrin response to standard meal provocative testing. RESULTS For patients with fasting serum gastrin levels less than 1,000 pg/mL (n = 43), only 44% had a less than 50% increase over the pre-meal value, which is reported to be the typical response in ZES, and 40% had a 50% to 99% increase. Furthermore 16% had a 100% or greater increase, 9% a 150% or greater increase, and 5% a 200% or greater increase, which overlaps with values reported to be characteristic of 98%, 92%, and 46% of patients with antral syndromes. Results did not differ for patients with or without MEN-I, depend on the extent of the gastrinoma (duodenal versus pancreatic gastrinomas), the presence of previous gastric surgery or type of gastric surgery, or for patients with fasting serum gastrin concentrations greater than or equal to 1,000 pg/mL or less than 1,000 pg/mL. studies of four patients before and after resection of the gastrinoma, who prior to surgery had a greater than 100% increase in gastrin secretion after the meal, demonstrated that all patients had a less than 100% increase postoperatively even though no gastric resection was done. CONCLUSIONS Approximately half of the patients with ZES have a greater than 50% increase in serum gastrin concentration following a standard test meal and one fifth have a 100% or greater increase. Therefore, they cannot be distinguished on this basis from patients with antral syndromes. The increased serum gastrin level after the meal in these patients with ZES appears to be due to the gastrinoma. Furthermore, the current study provides no evidence for the proposals that antral syndromes are more common in patients with MEN-I, that gastric surgery affects the meal response in patients with gastrinomas, or that the meal test is useful in localizing duodenal gastrinomas.
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Affiliation(s)
- H Frucht
- Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892
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Chen J, Liu TH, Ye SF, Gu CF, Chen SP. Gastrin and somatostatin cells in dyspeptic patients with and without duodenal ulcer: a quantitative study based on multiple biopsy specimens. J Gastroenterol Hepatol 1989; 4:41-7. [PMID: 2577464 DOI: 10.1111/j.1440-1746.1989.tb00805.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The numbers of immunoreactive gastrin and somatostatin cells in gastric and duodenal mucosal biopsy specimens from dyspeptic patients with duodenal ulcers and dyspeptic controls without ulcers were calculated using a morphometric method. The levels of gastrin and somatostatin in the tissue were also measured by the radioimmunoassay. The results showed no significant difference in the number of G cells and the level of gastrin in the tissue between the ulcer and non-ulcer groups. However, the number of D cells and the level of somatostatin in the tissue in ulcer patients were remarkably reduced in comparison with those in non-ulcer patients (P less than 0.01 and P less than 0.05, respectively). The G:D cells and gastrin:somatostatin ratios in ulcer patients were much higher than those in the non-ulcer control group. It is considered that the reduction of D cells and the relative lack of somatostatin in duodenal ulcer patients might have a role in the mechanism of the duodenal ulceration.
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Affiliation(s)
- J Chen
- Peking Union Medical College Hospital, Beijing, People's Republic of China
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Affiliation(s)
- M M Wolfe
- Harvard Digestive Diseases Center, Harvard-Torndike Laboratory, Beth Israel Hospital, Boston, MA 02215
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Solcia E, Usellini L, Buffa R, Rindi G, Villani L, Zampatti C, Silini E. Endocrine cells producing regulatory peptides. EXPERIENTIA 1987; 43:839-50. [PMID: 3297770 DOI: 10.1007/bf01945362] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent data on the immunolocalization of regulatory peptides and related propeptide sequences in endocrine cells and tumors of the gastrointestinal tract, pancreas, lung, thyroid, pituitary (ACTH and opioids), adrenals and paraganglia have been revised and discussed. Gastrin, xenopsin, cholecystokinin (CCK), somatostatin, motilin, secretin, GIP (gastric inhibitory polypeptide), neurotensin, glicentin/glucagon-37 and PYY (peptide tyrosine tyrosine) are the main products of gastrointestinal endocrine cells; glucagon, CRF (corticotropin releasing factor), somatostatin, PP (pancreatic polypeptide) and GRF (growth hormone releasing factor), in addition to insulin, are produced in pancreatic islet cells; bombesin-related peptides are the main markers of pulmonary endocrine cells; calcitonin and CGRP (calcitonin gene-related peptide) occur in thyroid and extrathyroid C cells; ACTH and endorphins in anterior and intermediate lobe pituitary cells, alpha-MSH and CLIP (corticotropin-like intermediate lobe peptide) in intermediate lobe cells; met- and leu-enkephalins and related peptides in adrenal medullary and paraganglionic cells as well as in some gut (enterochromaffin) cells; NPY (neuropeptide Y) in adrenaline-type adrenal medullary cells, etc.. Both tissue-appropriate and tissue-inappropriate regulatory peptides are produced by endocrine tumours, with inappropriate peptides mostly produced by malignant tumours.
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Nielsen HO. The antral gastrin-producing cells in duodenal ulcer patients. A study of preoperative G-cell densities, fasting serum-gastrin, pre- and postoperative gastric acid secretion and outcome after parietal cell vagotomy. ACTA PATHOLOGICA, MICROBIOLOGICA, ET IMMUNOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1987; 95:99-101. [PMID: 3565011 DOI: 10.1111/j.1699-0463.1987.tb00013_95a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Antral gastrin-producing cell densities, as well as serum gastrin and gastric acid secretion were obtained prior to parietal cell vagotomy from 60 patients suffering from chronic duodenal ulcer disease. Acid secretion was also measured postoperatively. The patients were followed for five years. The ulcer recurrence rate was 20%. No differences were found in the G-cell densities, fasting serum-gastrin or gastric acid secretion preoperatively between the two groups: recurrence and non-recurrence. The acid secretion was higher postoperatively in patients with recurrent ulcer as compared to those without recurrence of the ulcer, suggesting that incomplete vagotomy is a reasonable explanation of the recurrence, even though post-operative G-cell abnormality cannot definitely be ruled out.
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Torres AJ, Ortega L, Blanco J, Fernandez-Durango R, Hernandez F, Suarez A, Cuberes R, Sanz J, Balibrea JL. Antral gastrin-producing G-cells and somatostatin-producing D-cells in peptic ulcer. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1987; 410:165-71. [PMID: 2879377 DOI: 10.1007/bf00710821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The number of G cells and D cells per area unit and the G cell/D cell ratio was studied in control subjects and patients with duodenal or gastric ulcer. A great inter-individual variation in the population density of both types of cells was observed in the three groups studied. G cell density was significantly decreased in both duodenal and gastric ulcer patients, when compared with controls; whereas no difference in G cell density was seen between duodenal ulcer patients and gastric ulcer patients. However, D cell density was significantly decreased in duodenal ulcer patients when compared with control subjects and gastric ulcer patients. In this latter group, D cell density was also lower than in control subjects. A significant positive linear correlation between G cell number and D cell number was found in the three groups studied. The G cell/D cell ratio was significantly increased in duodenal and gastric ulcer patients when compared with controls. This was mainly due to a decrease in D cell numbers. It is concluded that a local deficit in antral D cells in patients with peptic ulcer may favor the pathogenesis of ulcer disease.
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Clark CG, Chowcat NL, Lewin MR, Gilbert JM, Gelister JS, Boulos PB. Surgery for peptic ulceration associated with hypergastrinaemia. Br J Surg 1986; 73:248-52. [PMID: 2870756 DOI: 10.1002/bjs.1800730403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Between 1971 and 1983, 31 males and 13 females were found to have peptic ulceration associated with hypergastrinaemia. An antral G-cell lesion was present in 11 (25 per cent) and a gastrinoma in 14 (32 per cent). There were 11 patients with multiple endocrine adenomatosis (MEA) (25 per cent) and 4 (9 per cent) with primary hyperparathyroidism. Four patients (9 per cent) were unclassified. Length of history and level of gastrin did not differentiate between the groups and an average of 2.5 operations was performed per patient, while the overall mortality was 27.3 per cent. The patients with G-cell lesions were significantly younger than all the other groups (P less than 0.01). Partial gastrectomy adequately treated G-cell hyperplasia. Total gastrectomy was required to treat pancreatic gastrinomata but additional pancreatic resection did not improve the outcome. In MEA, parathyroidectomy did not influence the treatment of a gastrinoma. This is the first recorded experience of surgery for hypergastrinaemia in the United Kingdom and the outcome of such a retrospective study may be a guide to the future management of these conditions.
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Invited commentary. World J Surg 1985. [DOI: 10.1007/bf01656333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cooper RG, Dockray GJ, Calam J, Walker R. Acid and gastrin responses during intragastric titration in normal subjects and duodenal ulcer patients with G-cell hyperfunction. Gut 1985; 26:232-6. [PMID: 3972270 PMCID: PMC1432614 DOI: 10.1136/gut.26.3.232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Amino acid induced acid and gastrin responses during intragastric titration at pH 2.5 and 5.5 were compared in normal subjects and duodenal ulcer patients with G-cell hyperfunction. The latter were identified on the basis of raised basal or maximal acid outputs and increased gastrin responses to feeding. In normal subjects the mixed amino acid meal stimulated only modest increases in serum gastrin, and the highest observed increase was about 30% that after a standard meal. In contrast, in the G-cell hyperfunction group the highest gastrin concentrations were similar to those after a standard meal. In the G-cell hyperfunction group the increment in serum gastrin at pH 2.5 expressed as a proportion of that at pH 5.5 was 0.29 indicating that the capacity of acid to inhibit gastrin release was well established in these patients. Acid secretory rates were close to maximal at both pH 2.5 and 5.5 during intragastric titration in the ulcer patients, but in normal subjects acid output was about 50% maximal at 2.5 and close to maximal at 5.5. The results suggest that the enhanced gastrin response to feeding in G-cell hyperfunction patients is because of increased sensitivity to amino acid stimulation rather than to diminished acid-inhibitory mechanisms.
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Friesen SR, Tomita T. Further experience with Pseudo-Zollinger-Ellison syndrome: its place in the management of neuroendocrine duodenal ulceration. World J Surg 1984; 8:552-60. [PMID: 6485353 DOI: 10.1007/bf01654936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Morgan JE, Kaiser CW, Johnson W, Doos WG, Dayal Y, Berman L, Nabseth D. Gastric carcinoid (gastrinoma) associated with achlorhydria (pernicious anemia). Cancer 1983; 51:2332-40. [PMID: 6189574 DOI: 10.1002/1097-0142(19830615)51:12<2332::aid-cncr2820511228>3.0.co;2-i] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This report presents a case of multicentric gastric carcinoid (gastrin containing) tumors of the fundus associated with achlorhydria and pernicious anemia. It is suggested that stimulation of the antral G cells and possibly fundic argyrophilic cells by achlorhydria associated with atrophic gastritis may lead to hyperplasia, and eventually to neoplasia in the latter, in the form of gastric carcinoid with gastrin production.
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Hartman PE. Mutagens: some possible health impacts beyond carcinogenesis. ENVIRONMENTAL MUTAGENESIS 1983; 5:139-52. [PMID: 6861723 DOI: 10.1002/em.2860050204] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Considerable attention is currently being given to the roles of environmental and endogenous mutagens in tumor induction and in tumor progression through the abilities of mutagens to induce one or another kind of somatic mutation. It is proposed here that mutagens, also through induction of somatic mutations, initiate a spectrum of additional, much more common, focal lesions that are important to the human condition. While individually they are of relative insignificance and thus neglected by many clinicians, the functional attributes of these focal lesions have important impacts on human physiology and thus contribute substantially to the process of aging. Additionally, one individual focus may progress to an extent that it produces clinically recognizable symptoms and may even jeopardize the carrier's life. The ultimate and developed expression of these lesions is heterogeneous, is far removed in time from initial induction, and relies on additional host and environmental factors for expression; therefore, the possible role of somatic mutation is readily overlooked. The focal lesions reviewed are fibrous atherosclerotic plaques, senile cataracts, and metaplasias. Literature that implicates metaplasias as precursor or as predisposing lesions in the ultimate formation of gallstones, duodenal ulcers, and adenocarcinomas is summarized.
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Abstract
An assessment of treatment methods for the Zollinger-Ellison syndrome over 25 years suggests that the dual surgical approach of excision of resectable tumor and total gastrectomy provides the greatest possibility of attaining tumor and serum gastrin control. Normal serum gastrin levels and reduction of tumor status, not observed with nonoperative management, were attained by surgical treatment, particularly when the tumor (or hyperplasia) was limited to the pancreas, stomach, duodenum and regional lymph nodes. Eleven of 16 such operations resulted in tumor control, and 10 of these patients developed normal serum gastrin concentrations. In elective clinical situations combined medical and surgical therapy is a rational approach allowing confirmation of diagnosis and safe, definitive surgical control of the syndrome before metastases occur.
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Grube D. [The endocrine cells of the digestive system (author's transl)]. KLINISCHE WOCHENSCHRIFT 1982; 60:213-27. [PMID: 6122753 DOI: 10.1007/bf01728340] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Endocrine cells occur in the digestive system as micro-organs (islets of Langerhans) or scattered throughout the epithelium of the gastrointestinal tract ("diffuse endocrine epithelial organ" of Feyrter). These gastro-entero-pancreatic (GEP) endocrine cells synthesize--in addition to serotonin--a great variety of polypeptide hormones, which regulate both carbohydrate metabolism and digestive processes. The present review deals mainly with cytology and cytochemistry of GEP endocrine cells. A synopsis is presented of the 19 endocrine cell types identified to date, which includes their update nomenclature and their anatomical distribution pattern. Morphological-functional aspects of cell biology, pathology, and cytogenesis of theses cells and their position within superimposed systems (APUD cells, paraneurons) are discussed.
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Abstract
The purpose of the investigation was to detect ulcer patients having nontumorous hypergastrinemic hyperchlorhydria and to diagnostically differentiate this pseudo-Zollinger-Ellison syndrome from neurogenic duodenal ulcer disease and pancreatic gastrinomas. Nine patients having clinical, radiologic and humoral findings simulating the Zollinger-Ellison syndrome or severe duodenal ulcer disease were studied by physiologic provocative testing. The patients, not having pancreaticoduodenal gastrinomas, had an antral mucosal source of their moderate hypergastrinemia even after vagotomy with drainage, which was eliminated in eight patients treated by surgical antrectomy, resulting in normal serum gastrin concentrations. The pseudo-Zollinger-Ellison syndrome is, thus, characterized physiologically by an exaggerated gastrin response to meals, no response to secretin stimulation and pathologically by hyperfunctioning hyperplastic G cells of the antrum. The clinical, physiologic, pathologic and surgical features were integrated for accurate diagnosis and treatment.
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Abstract
Gastrointestinal hormones (GI hormones) have received growing interest in endocrinology, gastroenterology and neuroendocrinology. Because of new methodological techniques, they can be measured in plasma and therefore be related to different pathophysiological conditions. In childhood, our present knowledge is as yet limited to the physiological rôle of gastrin at different ages and in some diseases (gastrinoma; Verner-Morrison syndrome) caused by humoral dysfunction. The present review relates the clinical important GI hormones to chemically classified families. The diagnostic value of determining endogenous hormone concentration in plasma and the validity of function tests carried out by administration of exogenous hormones are pointed out. Particular emphasis is given to the trophic action of GI hormones in the development and function of the gastrointestinal tract during childhood. More speculatively, GI hormones are involved in the complex function of the central nervous system, thus making food intake a trophotropic action in a broader sense.
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Nielsen HO, Halken S, Lorentzen M. Quantitative studies of the gastrin-producing cells of the human antrum. A methodological study. ACTA PATHOLOGICA ET MICROBIOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1980; 88:255-61. [PMID: 7004076 DOI: 10.1111/j.1699-0463.1980.tb02494.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The antral gastrin-producing cells (G-cells) have been identified by the indirect immunoperoxidase technique in two antrum preparations removed due to a recurrent duodenal and gastric ulcer. Morphometric principles were applied to the G-cells with determination of their volume density, numerical density, and mean cell volume. The study showed that within-observer variation, between-observer variation and within-patient variation were negligible, provided at least 200 G-cells were counted. A biopsy material can be used, as well as larger tissue blocks, when this minimum sample size is respected. A method for estimating the total G-cell population and the total G-cell volume in the antrum was developed. In the antrum removed due to a gastric ulcer the number of G-cells was 190 x 10(6) and their total volume 176 mm3.
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McIntyre R, Piris J. Quantification of human gastric G cell density in endoscopic biopsy specimens: effect of shape of specimen. J Clin Pathol 1980; 33:513-6. [PMID: 7400353 PMCID: PMC1146133 DOI: 10.1136/jcp.33.6.513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Experiments performed on endoscopic biopsy specimens show that when they are curved, as they often are, the inner surface of the mucosa is contracted and the outer surface is expanded. When estimating G cell numbers per unit length of mucosa from such biopsy specimens, artefacts produced by variations in shape are minimised by relating the number of G cells to the mean of the length of the muscularis mucosae and the length of the outer mucosal profile on the tissue section containing these cells.
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Pont A. Multiple endocrine neoplasia syndromes. West J Med 1980; 132:301-12. [PMID: 6247851 PMCID: PMC1272066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The multiple endocrine neoplasia (MEN) syndromes consist of three distinct disease entities. They have in common adenomatous, carcinomatous or hyperplastic involvement of a variety of endocrine glands, and an autosomal dominant inheritance. MEN I includes hyperparathyroidism, islet cell and pituitary tumors. The components of MEN IIa are hyperparathyroidism, medullary thyroid carcinoma and pheochromocytoma. MEN IIb includes multiple neuromas, medullary thyroid carcinoma and pheochromocytoma. Effective tests are available for the early detection of components of the syndromes in potentially affected patients. Screening can lead to therapeutic intervention before clinical sequelae ensue.
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