Limits...
Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?

Jaenigen B, Kayser G, Steinke B, Thomusch O - Case Rep Med (2009)

Bottom Line: Background.Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany.

ABSTRACT
Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma. Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization. Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured. Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.

No MeSH data available.


Related in: MedlinePlus

Trabecular epithelial cell proliferation with positive expression of synatophysin (10x).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2734937&req=5

fig1: Trabecular epithelial cell proliferation with positive expression of synatophysin (10x).

Mentions: An abdominal computer tomography was performed to locate the gastrinoma, but no suspected lesion could be detected. Additionally, a Somatostatin receptor scintiscan could also not determine the focus. The patient was presented in our department to plan further treatment. After a Dopa PET failed to localize the gastrinoma, an explorative laparotomy was performed in April 2004. First, the duodenum and the pancreas head were exposed by carrying out a Kocher's manoeuvre. Then, the pancreas corpus and tail were completely mobilized. Palpation and intraoperative ultrasonography showed a normal pancreas without any suspicious pancreatic tumour. An enlarged lymph node (1 × 0.5 cm) was removed from the retropancreatic region. Instantaneous section found glandular structures matching a gastrinoma. Subsequently. a complete lymphadenectomy of the retropancreatic area and the hepatoduodenal ligament was performed. A second enlarged lymph node was extirpated behind the common bile duct. Finally, a duodenotomy of pars II was performed. Despite careful examination, no duodenal lesion could be found and the surgery was completed. The histology of the specimen showed two lymph nodes infiltrated by a gastrinoma. An immunohistochemical preparation of the specimen showed a positive expression of gastrin, cytokeratin, chromogranin, and synaptophysin (see Figure 1).


Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?

Jaenigen B, Kayser G, Steinke B, Thomusch O - Case Rep Med (2009)

Trabecular epithelial cell proliferation with positive expression of synatophysin (10x).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2734937&req=5

fig1: Trabecular epithelial cell proliferation with positive expression of synatophysin (10x).
Mentions: An abdominal computer tomography was performed to locate the gastrinoma, but no suspected lesion could be detected. Additionally, a Somatostatin receptor scintiscan could also not determine the focus. The patient was presented in our department to plan further treatment. After a Dopa PET failed to localize the gastrinoma, an explorative laparotomy was performed in April 2004. First, the duodenum and the pancreas head were exposed by carrying out a Kocher's manoeuvre. Then, the pancreas corpus and tail were completely mobilized. Palpation and intraoperative ultrasonography showed a normal pancreas without any suspicious pancreatic tumour. An enlarged lymph node (1 × 0.5 cm) was removed from the retropancreatic region. Instantaneous section found glandular structures matching a gastrinoma. Subsequently. a complete lymphadenectomy of the retropancreatic area and the hepatoduodenal ligament was performed. A second enlarged lymph node was extirpated behind the common bile duct. Finally, a duodenotomy of pars II was performed. Despite careful examination, no duodenal lesion could be found and the surgery was completed. The histology of the specimen showed two lymph nodes infiltrated by a gastrinoma. An immunohistochemical preparation of the specimen showed a positive expression of gastrin, cytokeratin, chromogranin, and synaptophysin (see Figure 1).

Bottom Line: Background.Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany.

ABSTRACT
Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma. Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization. Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured. Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.

No MeSH data available.


Related in: MedlinePlus