A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands
Abstract Background Primary hepatic gastrinoma causing severe ulcerogenic syndrome is extremely rare. Herein, we report a case of primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands in a patient who instead, preoperatively, was suspected of having multiple duodena...
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doaj-5a12382e4bcc4834b94dffb4799d31932020-11-24T21:01:37ZengSpringerOpenSurgical Case Reports2198-77932017-11-01311610.1186/s40792-017-0392-1A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glandsTakaomi Hagi0Yohei Hosoda1Izumi Komoto2Shinji Uemoto3Susumu Hijioka4Yoshiro Taki5Kazuhiro Nishiyama6Masayuki Imamura7Department of Gastroenterological Surgery, Kansai Electric Power HospitalDepartment of Gastroenterological Surgery, Kansai Electric Power HospitalDepartment of Gastroenterological Surgery, Kansai Electric Power HospitalDepartment of Hepato-Biliary-Pancreatic and Transplantation Surgery, Graduate School of Medicine, Kyoto UniversityDepartment of Gastroenterology, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Kansai Electric Power HospitalDepartment of Gastroenterological Surgery, Kansai Electric Power HospitalDepartment of Gastroenterological Surgery, Kansai Electric Power HospitalAbstract Background Primary hepatic gastrinoma causing severe ulcerogenic syndrome is extremely rare. Herein, we report a case of primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands in a patient who instead, preoperatively, was suspected of having multiple duodenal gastrinomas and hepatic metastasis. Case presentation A 57-year-old woman consulted a clinic complaining of melena, intermittent abdominal pain, diarrhea, and vomiting which had persisted for about 3 years. Six months before her presentation, she underwent segmental resection of the jejunum for acute peritonitis due to the spontaneous jejunal perforation. A blood test revealed that her serum immunoreactive gastrin (IRG) level was 12,037 pg/mL. Subsequently, she was transferred to our hospital. On computed tomography (CT), a hypervascular tumor of 23 mm in the segment 5 (S5) region of the liver was visualized. A selective arterial secretagogue injection test (SASI test) was performed twice. The first SASI test revealed that the hepatic tumor was a gastrinoma, and there was no gastrinoma in the duodeno-pancreatic region. Additionally, somatostatin receptor scintigraphy only visualized the tumor in the liver. However, the second SASI test, which was performed during the administration of a proton pump inhibitor and a somatostatin analog (octreotide acetate), revealed that there may have been gastrinomas existing not only in the liver but also in the upper part of the duodenum or the head of the pancreas. Duodenal endoscopy revealed multiple submucosal tumors in the first and the second portion of the duodenum, although a pathological examination of biopsied specimens obtained from the duodenal lesions was negative for malignant cells. Multiple endocrine neoplasia type 1 (MEN1) was excluded from her family history, and serum levels of both intact parathyroid hormone (iPTH) and calcium were within normal ranges. An anterior segmentectomy of the liver and pancreas-preserving total duodenectomy were performed on September 9, 2013. Postoperatively, her serum immunoreactive gastrin level decreased to less than 50 pg/mL. Pathological study of the resected specimens revealed a gastrinoma in the liver, but no gastrinoma in the duodenum. Interestingly, the duodenal submucosal tumor-like lesions were hyperplastic Brunner’s glands. Postoperatively, she has been well without recurrence of hypergastrinemia for 4 years. Conclusion We report a case of primary hepatic gastrinoma in a patient who has been cured for 4 years postoperatively. The diagnosis was somewhat difficult due to the coexisting, multiple hyperplastic Brunner’s glands of the duodenum mimicking the submucosal neuroendocrine tumors, which might have developed due to long-term hypergastrinemia.http://link.springer.com/article/10.1186/s40792-017-0392-1Primary hepatic gastrinomaHyperplasia of Brunner’s glandsHypergastrinemiaSelective arterial secretagogue injection testSomatostatin receptor scintigraphyPancreas-preserving total duodenectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Takaomi Hagi Yohei Hosoda Izumi Komoto Shinji Uemoto Susumu Hijioka Yoshiro Taki Kazuhiro Nishiyama Masayuki Imamura |
spellingShingle |
Takaomi Hagi Yohei Hosoda Izumi Komoto Shinji Uemoto Susumu Hijioka Yoshiro Taki Kazuhiro Nishiyama Masayuki Imamura A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands Surgical Case Reports Primary hepatic gastrinoma Hyperplasia of Brunner’s glands Hypergastrinemia Selective arterial secretagogue injection test Somatostatin receptor scintigraphy Pancreas-preserving total duodenectomy |
author_facet |
Takaomi Hagi Yohei Hosoda Izumi Komoto Shinji Uemoto Susumu Hijioka Yoshiro Taki Kazuhiro Nishiyama Masayuki Imamura |
author_sort |
Takaomi Hagi |
title |
A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands |
title_short |
A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands |
title_full |
A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands |
title_fullStr |
A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands |
title_full_unstemmed |
A primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands |
title_sort |
primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular brunner’s glands |
publisher |
SpringerOpen |
series |
Surgical Case Reports |
issn |
2198-7793 |
publishDate |
2017-11-01 |
description |
Abstract Background Primary hepatic gastrinoma causing severe ulcerogenic syndrome is extremely rare. Herein, we report a case of primary hepatic gastrinoma accompanied by hyperplasia of multi-nodular Brunner’s glands in a patient who instead, preoperatively, was suspected of having multiple duodenal gastrinomas and hepatic metastasis. Case presentation A 57-year-old woman consulted a clinic complaining of melena, intermittent abdominal pain, diarrhea, and vomiting which had persisted for about 3 years. Six months before her presentation, she underwent segmental resection of the jejunum for acute peritonitis due to the spontaneous jejunal perforation. A blood test revealed that her serum immunoreactive gastrin (IRG) level was 12,037 pg/mL. Subsequently, she was transferred to our hospital. On computed tomography (CT), a hypervascular tumor of 23 mm in the segment 5 (S5) region of the liver was visualized. A selective arterial secretagogue injection test (SASI test) was performed twice. The first SASI test revealed that the hepatic tumor was a gastrinoma, and there was no gastrinoma in the duodeno-pancreatic region. Additionally, somatostatin receptor scintigraphy only visualized the tumor in the liver. However, the second SASI test, which was performed during the administration of a proton pump inhibitor and a somatostatin analog (octreotide acetate), revealed that there may have been gastrinomas existing not only in the liver but also in the upper part of the duodenum or the head of the pancreas. Duodenal endoscopy revealed multiple submucosal tumors in the first and the second portion of the duodenum, although a pathological examination of biopsied specimens obtained from the duodenal lesions was negative for malignant cells. Multiple endocrine neoplasia type 1 (MEN1) was excluded from her family history, and serum levels of both intact parathyroid hormone (iPTH) and calcium were within normal ranges. An anterior segmentectomy of the liver and pancreas-preserving total duodenectomy were performed on September 9, 2013. Postoperatively, her serum immunoreactive gastrin level decreased to less than 50 pg/mL. Pathological study of the resected specimens revealed a gastrinoma in the liver, but no gastrinoma in the duodenum. Interestingly, the duodenal submucosal tumor-like lesions were hyperplastic Brunner’s glands. Postoperatively, she has been well without recurrence of hypergastrinemia for 4 years. Conclusion We report a case of primary hepatic gastrinoma in a patient who has been cured for 4 years postoperatively. The diagnosis was somewhat difficult due to the coexisting, multiple hyperplastic Brunner’s glands of the duodenum mimicking the submucosal neuroendocrine tumors, which might have developed due to long-term hypergastrinemia. |
topic |
Primary hepatic gastrinoma Hyperplasia of Brunner’s glands Hypergastrinemia Selective arterial secretagogue injection test Somatostatin receptor scintigraphy Pancreas-preserving total duodenectomy |
url |
http://link.springer.com/article/10.1186/s40792-017-0392-1 |
work_keys_str_mv |
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