Ulcerogenic Tumors of the Duodenum*

Oberhelman, Harry A.; Nelsen, Thomas S.; Johnson, Alstrup N.; Dragstedt, Lester R.

doi:10.1097/00000658-196115320-00008

Cited by 94 publications

(27 citation statements)

References 3 publications

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“…However, if not only the 10 patients in whom we identified gastrinomas are considered but the 2 patients with "lymph node gastrinomas" are added, the malignancy rate increases to 58% (7 of 12 patients). This figure is similar to that found in our series of sporadic duodenal and pancreatic gastrinomas and compares well with the respective data extracted from the literature [8,25,29,34,39,44,65,72]. We therefore cannot confirm previous reports that ascribe a higher malignancy rate to sporadic gastrinomas [34,65].…”

Section: Are There Major Differences In the Pathology Of Sporadic Gas...supporting

confidence: 85%

“…The existence of duodenal tumors with an ulcerogenic potential was first noted by Oberhelman and colleagues [8,50], and they had emphasized the small size of these lesions. Since then it has been repeatedly shown that duodenal endocrine tumors (gastrinomas and others) may be tiny lesions [45,[51][52][53].…”

mentioning

confidence: 96%

“…Originally they thought that glucagon caused the clinical entity, now known as the Zollinger-Ellison syndrome (ZES), but a few years later gastrin was identified as the hormone accounting for ZES [6]. Gastrinomas, as these tumors were then appropriately called [7], were initially thought to originate only in the pancreas, but in 1961 Oberhelman and collaborators reported ulcerogenic tumors in the duodenum [8]. Subsequent reports describing gastrinomas at other extrapancreatic sites, such as the stomach, jejunum, liver, ovary, kidney, and lymph nodes, further confirmed the notion that gastrinomas may arise from a number of extrapancreatic locations [%22].…”

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confidence: 99%

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Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I

et al. 1993

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During the three decades since the recognition of the Zollinger-Ellison syndrome (ZES), major progress has been made in the diagnosis and treatment of this disease. However, the many failed operations in patients with ZES, the existence of primary lymph node gastrinomas, and the surgical approach of patients with ZES and multiple endocrine neoplasia type I (MEN-I) have remained controversial issues. In this review, our experience with the pathology of immunocytochemically identified gastrinomas in 44 patients with ZES is presented and related to the relevant literature. (1) Gastrinomas occur frequently in the duodenum (> 40%) and are commonly small (< 1 cm). They can therefore easily be missed at surgical exploration; lymph node metastases from such occult gastrinomas may be mistaken for primary tumors. (2) Most pancreatic gastrinomas reside in the head of the gland and have a diameter of 1 to 3 cm. (3) Gastrinomas associated with MEN-I are predominantly of duodenal origin and frequently multicentric; sporadic gastrinomas are single and more often pancreatic. Because MEN-I associated pancreatic tumors seldom contain gastrin, ZES in MEN-I patients is almost never cured by resection of the pancreatic tumors. (4) The metastatic potential of most small duodenal gastrinomas seems to be restricted to the regional lymph nodes.

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Section: Are There Major Differences In the Pathology Of Sporadic Gas...supporting

confidence: 85%

mentioning

confidence: 96%

mentioning

confidence: 99%

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Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I

et al. 1993

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“…At present our knowledge about the natural history of pancreatic and duodenal microgastrinomas is limited [4,21]. However, the clinicopathologic nature of these tumors will be elucidated with increased success in the curative resection of microgastrinomas and the development of useful localization methods.…”

Section: Discussionmentioning

confidence: 99%

Use of selective arterial secretin injection test to guide surgery in patients with Zollinger‐Ellison syndrome

Imamura

Takahashi

1993

World j. surg.

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It is often difficult to localize gastrinomas in patients with Zollinger-Ellison syndrome (ZES). We have developed a new useful method, the selective arterial secretin injection test (SASI test), for localizing gastrinomas in patients with ZES. The SASI test first determines the arteries feeding the gastrinomas and then locates the gastrinomas. In 12 patients with ZES, the SASI test clearly localized the gastrinomas, while results obtained with computed tomography or portal venous blood sampling had a positive predictability of less than 10%. Following localization with the SASI test, curative resection of gastrinomas was successfully performed on 7 patients who consented to the operation. Each of 3 patients had one duodenal submucosal microgastrinoma and one or more metastatic lymph node; the other 4 patients had 2 to 10 microgastrinomas or large gastrinomas in the duodenum or the pancreas. All 7 patients, who exhibited negative responses with a postoperative secretin test, have been completely cured from 3 months to 4 years postoperatively. The usefulness of the SASI test for preoperative evaluation is demonstrated by the fact that it gives a 100% positive predictability rate as well as a 100% negative predictability rate. Hence the SASI test precisely locates functioning gastrinomas.

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“…Gastrinoma is a famous tumor, because it causes Zollinger-Ellison syndrome (ZES). Before 1990, doctors had thought that ZES was caused mostly by a large pancreatic gastrinoma, although Oberhelman et al had reported a few cases of duodenal gastrinoma as a cause of ZES in 1962 [47]. Since the resection of gastrinoma in patients with ZES guided by the SASI test started [6,23,24], it has been revealed that the resection of duodenal gastrinoma has cured ZES [6,7,14,18,[22][23][24][25][27][28][29].…”

Section: Gastrinomamentioning

confidence: 99%

Diagnosis of functioning pancreaticoduodenal neuroendocrine tumors

Imamura

Nakamoto

Uose

et al. 2015

J Hepato Biliary Pancreat

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Functioning pancreaticoduodenal neuroendocrine tumors (PD-NETs) are popular in a textbook, but they are still unfamiliar to a general clinician, and delay of diagnosis or misdiagnosis has been reported even today. It is a consensus that sporadic functioning PD-NET is cured only by surgical resection. So, early detection and early resection is the gold standard for the treatment of functioning PD-NET. Functioning PD-NETs in patients with multiple endocrine neoplasia type 1 (MEN 1) are often multiple. You should check about MEN 1 whenever you encountered multiple PD-NET. They are diagnosed in younger age than sporadic cases. In most cases they are accompanied with numerous microscopic or macroscopic nonfunctioning P-NETs, which are potentially metastatic and the most common cause of death in MEN 1 patients.

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Ulcerogenic Tumors of the Duodenum*

Cited by 94 publications

References 3 publications

Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I

Pathologic aspects of gastrinomas in patients with Zollinger‐Ellison syndrome with and without multiple endocrine neoplasia type I

Use of selective arterial secretin injection test to guide surgery in patients with Zollinger‐Ellison syndrome

Diagnosis of functioning pancreaticoduodenal neuroendocrine tumors

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