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

Abstract

Neuroendocrine tumors of the pancreas are being recognized with increasing frequency, not because the incidence has increased, but as a result of improvements in diagnostic tools such as radioimmunoassays for a variety of circulating peptides, and imaging methods that include positron emission tomography (PET) and immunoscintigraphy. Nevertheless, establishing the diagnosis of a neuroendocrine tumor is always a challenge to the clinician from both diagnostic and therapeutic perspectives. Liver transplantation as the ultimate therapeutic, or at least palliative, option for hepatic metastases has produced contradictory results over the past decade. We report herein the case of a 23-year-old woman who, after being diagnosed with gastrinoma in 1989, underwent the complete therapeutic array including liver transplantation for hepatic metastases in 1991. Although an extrahepatic tumor recurred 2 years later, for which double chemotherapy with 5-FU and streptozotocin was given, she is currently leading a normal life with a full-time job. This case prompted a critical review of the current literature on diagnosis and medical and surgical treatment.

Combined associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) followed by left trisectionectomy and Whipple operation for PNET

“…In the present critical situation of donor shortage, LT apply to PNET patients with liver metastases should be strictly controlled. It has been wildly accepted that only highly selected PNET patients with liver metastases may be candidates for LT (11)(12)(13). The only prospective study recommended strict selection criteria (i.e., low grade, removal of primary tumor, liver involvement <50%, age <55 years, and stable disease for ≥6 months before LT) for LT with curative treatment (13).…”

Liver transplantation and pancreatic resection: A single-center experience and a review of the literature

“…However, the performance of PR in association with LT is infrequent and will likely remain so, with little data available about outcomes. Neuroendocrine pancreatic tumors are a common indication for PR prior to LT 1, 5–23. These tumors often have a primary pancreatic origin and may progress to unresectable metastatic disease isolated to the liver.…”

Gastrinoma

“…Standard procedure Only a few cases of orthotopic liver transplantation have been reported in which liver lesions were multiple or unresectable [37,38]. Contraindications Inability to tolerate transplant or to continue with immunosuppressive protocols postoperatively.…”