Duodenal gastrinoma - Clinical features and usefulness of selective arterial secretin injection test

Atsuko Takasu, Toru Shimosegawa, Shin Fukudo, Tohru Asakura, Midori Uchi, Kenji Kimura, Junya Kashimura, Kennichi Satoh, Masaru Koizumi, Iwao Sasaki, Michio Hongo, Toshimitsu Suzuki, Takayoshi Toyota

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11 Citations (Scopus)

Abstract

Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but its clinical and biological features are not well known. Here we report a case of duodenal gastrinoma with lymph node metastasis which was confirmed by pathology examinations. Hypergastrinemia and gastric acid hypersecretion were documented, but the secretin test showed negative results. An enlarged peripancreatic lymph node lying close to the pancreas head was the only positive finding on preoperative imaging studies. The results of the selective arterial secretin injection (SASI) test suggested that the primary tumor was located in the gastrinoma triangle. Finally, surgical exploration was carried out and a submucosal tumor, approximately 15 mm in size, was detected by intraoperative palpation at the posterior wall of the proximal portion of the duodenum. Intraoperative pathology examination demonstrated metastases to regional lymph nodes. The present case calls attention to the unique features of duodenal gastrinomas, which differ from those of pancreatic origin: a highly malignant potential for its small size, and submucosal location in the proximal duodenum. The SASI test is recommended for assessing the location of a primary lesion if it cannot be identified by various conventional imaging studies.

Original languageEnglish
Pages (from-to)728-733
Number of pages6
JournalJournal of gastroenterology
Volume33
Issue number5
DOIs
Publication statusPublished - 1998 Oct 1

Keywords

  • Duodenal gastrinoma
  • Localization
  • SASI test
  • Secretin test
  • Zollinger-Ellison syndrome

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Takasu, A., Shimosegawa, T., Fukudo, S., Asakura, T., Uchi, M., Kimura, K., Kashimura, J., Satoh, K., Koizumi, M., Sasaki, I., Hongo, M., Suzuki, T., & Toyota, T. (1998). Duodenal gastrinoma - Clinical features and usefulness of selective arterial secretin injection test. Journal of gastroenterology, 33(5), 728-733. https://doi.org/10.1007/s005350050163