Clin Endosc.  2016 Sep;49(5):483-487. 10.5946/ce.2016.008.

Synchronous Peripancreatic Lymph Node Gastrinoma and Gastric Neuroendocrine Tumor Type 2

• Lee HW
• Chung JW
• Kim YJ
• Kwon KA
• Kim EJ
• Kim KK
• Lee WK
• Sym SJ

• KMID: 2356058
• DOI: http://doi.org/10.5946/ce.2016.008

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.

Keyword

Gastrinoma; Neuroendocrine tumors; Zollinger-Ellison syndrome

MeSH Terms

Adult
Gastrinoma*
Gastrins
Humans
Lymph Nodes*
Neoplasm Metastasis
Neuroendocrine Tumors*
Pancreas
Stomach
Tomography, X-Ray Computed
Ulcer
Zollinger-Ellison Syndrome
Gastrins

Figure

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  Fig. 1. Endoscopic imaging. (A) Esophagogastroduodenoscopy showing a localized hyperemic elevated lesion, with central umbilication, located at the greater curvature of the gastric high body. (B) Endoscopic ultrasonography revealing an 8×9-mm, oval shaped, homogeneous, hypoechoic lesion that originated from the submucosal layer.

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  Fig. 2. Computed tomography (CT). (A) CT revealing a 3×3.5×8-cm homogeneous retroperitoneal mass behind the pancreas (black arrow). (B) CT performed 6 years prior to diagnosis showing that the retroperitoneal mass was present at the same site, and had been overlooked (white arrow).

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  Fig. 3. Liver magnetic resonance imaging. Liver magnetic resonance imaging demonstrating (arrows) several additional liver lesions with slightly (A) low signal intensity on T1-weighted images, and (B) high signal intensity on T2-weighted images.

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  Fig. 4. Histologic examinations of retroperitoneal lymph nodes. (A) The resected lymph node showing a well-demarcated, solid grayish-tan lesion, 8×3 cm in size, with punctuate foci of hemorrhage. (B) H&E stain (×100) demonstrating that the tumor was composed of an organoid nest, and that it had trabecular growth pattern. Immunohistochemically, the tumor cells were reactive for (C) chromogranin A (×200) and (D) synaptophysin (×200).

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