Clin Endosc.  2013 Sep;46(5):582-585.

Gastric Somatostatinoma: An Extremely Rare Cause of Upper Gastrointestinal Bleeding

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand. kaiyjr@gmail.com
  • 2Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok, Thailand.
  • 3Department of Pathology, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand.

Abstract

A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.

Keyword

Somatostatinoma; Stomach metastasis; Endosonography; Neuroendocrine tumors

MeSH Terms

Biopsy, Fine-Needle
Carbamates
Diarrhea
Endoscopy
Endosonography
Female
Hemorrhage
Humans
Lymphatic Diseases
Middle Aged
Neuroendocrine Tumors
Organometallic Compounds
Somatostatinoma
Stomach
Weight Loss
Carbamates
Organometallic Compounds

Figure

  • Fig. 1 Endoscopic view showing (A) a large subepithelial gastric mass and (B) duodenal invasion with bleeding.

  • Fig. 2 (A) Endosonographic view showing a large isoechoic mass arising from the third and fourth layer, heterogeneous hypoechoic lymph nodes, suspected metastatic lymph nodes. (B) A computed tomography scan showing a large gastric mass with peripancreatic lymphadenopathy.

  • Fig. 3 (A) Gross pathology showing a tan-colored rounded mass with a rubbery consistency and whitish streaks of fibrosis. (B) Histopathology showing tumor cells with salt and pepper nuclear chromatin (H&E stain, ×20). The tumor was arranged in solid nests or in an acinar pattern. The tumor cells were cuboidal with ample granular eosinophilic cytoplasm including characteristic histologic feature of psammoma bodies (arrows) which supported somatostatinoma. (C) Synaptophysin showed diffuse positivity in the cytoplasm (×4). (D) Somatostatin staining showing a positive result (×40).


Reference

1. Larsson LI, Hirsch MA, Holst JJ, et al. Pancreatic somatostatinoma: clinical features and physiological implications. Lancet. 1977; 1:666–668. PMID: 66472.
2. Zhang ZY, Zhang R, Wang L, et al. Diagnosis and treatment of pancreatic somatostatinoma: a case report. Chin Med J (Engl). 2008; 121:2363–2365. PMID: 19080351.
Article
3. Pernet C, Kluger N, Du-Thanh A, et al. Somatostatin-producing endocrine tumour of the duodenum associated with type 1 neurofibromatosis. Acta Derm Venereol. 2010; 90:320–321. PMID: 20526564.
Article
4. Arima H, Natsugoe S, Maemura K, et al. Asymptomatic somatostatinoma of the pancreatic head: report of a case. Surg Today. 2010; 40:569–573. PMID: 20496141.
Article
5. Yu RS, Chen Y, Wang LH, Xu XF, Jiang DY. A large functional somatostatinoma in the pancreatic tail: atypical CT appearances. Turk J Gastroenterol. 2009; 20:291–294. PMID: 20084576.
Article
6. Williamson JM, Thorn CC, Spalding D, Williamson RC. Pancreatic and peripancreatic somatostatinomas. Ann R Coll Surg Engl. 2011; 93:356–360. PMID: 21943457.
Article
7. Zhang B, Xie QP, Gao SL, Fu YB, Wu YL. Pancreatic somatostatinoma with obscure inhibitory syndrome and mixed pathological pattern. J Zhejiang Univ Sci B. 2010; 11:22–26. PMID: 20043348.
Article
8. Cao XP, Liu YY, Xiao HP, Li YB, Wang LT, Xiao P. Pancreatic somatostatinoma characterized by extreme hypoglycemia. Chin Med J (Engl). 2009; 122:1709–1712. PMID: 19719976.
9. Colović RB, Matić SV, Micev MT, Grubor NM, Atkinson HD, Latincić SM. Two synchronous somatostatinomas of the duodenum and pancreatic head in one patient. World J Gastroenterol. 2009; 15:5859–5863. PMID: 19998510.
10. Musumba CO, Usman-Saeed M, O'Toole P, Powell S, Smart HL. Persistent severe gastrointestinal bleeding in a man with metastatic somatostatinoma. Gut. 2012; 61:277–328. PMID: 21940726.
Article
11. Saifuddin T, Linder C, Banerjee B. Duodenal somatostatinoma presenting as upper gastrointestinal bleeding. Am J Gastroenterol. 1999; 94:1405–1408. PMID: 10235228.
Article
12. Rios A, Fernandez JA, Rodríguez JM, Lujan JA, Martínez E, Parrilla P. Massive upper gastrointestinal bleeding as a manifestation of somatostatinoma of the ampulla of vater. Dig Dis Sci. 2001; 46:2162–2165. PMID: 11680591.
13. Prachayakul V, Aswakul P, Pongprasobchai S, et al. Clinical characteristics, endosonographic findings and etiologies of gastroduodenal subepithelial lesions: a Thai referral single center study. J Med Assoc Thai. 2012; 95(Suppl 2):S61–S67. PMID: 22574531.
14. Angeletti S, Corleto VD, Schillaci O, et al. Use of the somatostatin analogue octreotide to localise and manage somatostatin-producing tumours. Gut. 1998; 42:792–794. PMID: 9691916.
Article
15. Kim JA, Choi WH, Kim CN, Moon YS, Chang SH, Lee HR. Duodenal somatostatinoma: a case report and review. Korean J Intern Med. 2011; 26:103–107. PMID: 21437171.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr