A case of jejunal gastrinoma diagnosed by percutaneous transhepatic portal venous sampling

Abstract

A 63-year-old male was admitted to our department for further examination of hypergastrinemia. Secretin provocation test and calcium infusion test suggested Zollinger-Ellison syndrome and percutaneous transhepatic portal venous sampling (PTPVS) demonstrated gastrinoma in the jejunum, although CT, ultrasonography and angiography could not accurately detect the location of the gastrinoma. Laparotomy findings showed a solid tumor 1.5 cm in diameter in the jejunal mesentery 5 cm distal to the ligament of Treitz, and primary gastrinoma was confirmed in the submucosa of the jejunum immediately adjacent to this tumor. An immunohistochemical study using the PAP method revealed gastrin secreting cells in the tumor. In addition to this case of jejunal gastrinoma, a review of literature in Japan and other countries was presented.

Primary jejunal gastrinoma: a case report and review of the literature

“…Primary jejunal gastrinomas are exceedingly rare, and data for long-term follow-up is limited. To our knowledge, only six cases of gastrinomas originating from the jejunal wall have been reported in the English literature to date (Table 1 ) [ 3 – 7 ].…”

“…Two more tumors in adjacent jejunal mesentery. Multiple liver metastases NP Excision of jejunum tumors + remnant gastrectomy 10 years Alive and in stable condition Nishiwaki et al 1992 [ 7 ] M/63 787–1913 A primary gastrinoma in the submucosa of the jejunum. A lymph node metastasis (1.5 cm) in the jejunal mesentery 5 cm distal to the ligament of Treitz NP Partial resection of jejunum and pancreatocduodenectomy (on the suspicion of multiple primary sites) 7 months Alive and remained eugastrinemic Wu et al 1997 [ 3 ] M/35 460 Jejunum (distance from the ligament of Treitz not mentioned) NP Tumor resection by enucleation 134 months Elevated FSG at 2 years, local recurrence at 11 years M male, F female, FSG fasting serum gastrin, NP not provided …”

“…Primary jejunal gastrinomas are exceedingly rare, and data for long-term follow-up is limited. Until now, only six cases of gastrinomas arising from the jejunum have been reported in the English literature [ 3 – 7 ]. Presented is a case of a primary gastrinoma located in the proximal jejunum, which is a possible diagnosis when a jejunum tumor is detected by radiographic examination.…”

Diagnosis and Management of Metastatic Gastrinoma by Multimodality Treatment Including Liver Transplantation: Report of a Case

“…[19][20][21][22][23][24][25][26][27][28][29] In selected cases, percutaneous transhepatic portal blood sampling may help to localize the tumor. 20,28 The high level of somatostatin receptors on these tumors, and the commercial availability of octreotide has made possible 111 I-labeled DTPA-D-Phe-octreotide scanning, but this is still being evaluated. 29 As for hepatic metastases, according to some authors, radionuclide scintigraphy continues to play an important role, even with the development of these new methods and PET scanning.…”