Rare Occurrence of Hypergastrinemia Due to Thoracic Neuroendocrine Tumor: Detection and Characterization by 68Ga-DOTATATE PET/CT

Primary thoracic gastrinoma causing Zollinger-Ellison syndrome

Gastrinomas are located largely in the pancreaticoduodenal region. However, gastrinomas have also been found in non-pancreaticoduodenal regions. Our study is a rare report of gastrinomas within the thoracic cavity. A 53-year-old male patient presented with acute abdomen and multiple prepyloric ulcers. Serum gastrin level was significantly elevated. Computed tomography (CT) scan of the chest, abdomen, and pelvis showed a mass in the inferior section of the right hemithorax. Octreotide scan also confirmed a neuroendocrine tumor (NET)-like mass in the right para-aortic region in the right hemithorax. In thoracotomy, a hypervascular solid tumor was detected adjacent to the aorta, also receiving a branch from the aorta. We ligated the feeding artery and resected the 3-cm tumor. The post-operative serum gastrin level was 36 pg/mL, which implied that the tumor was successfully resected. The pathology assessment reported nests of monotonous low-grade neuroendocrine cells with salt and pepper nuclei with rare mitotic features, cellular uniformity, and abundant amphophilic cytoplasm, confirming the diagnosis of gastrinoma. Based on our report, we suggest that the search for gastrinomas should include not only the abdominal sites but also uncommon areas like the thoracic cavity.