Figure 1. Esophago-gastro-duodenoscopy images. (A) Reflux esophagitis (Los Angeles B). (B) Erosive antral gastritis. (C) Bulbar ulcer. (D) Erosive duodenitis.
| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Case Report
Volume 10, Number 11, November 2018, pages 843-847
Gastrinoma of Cystic Duct: A Rare Association With Multiple Endocrine Neoplasia Type 1
Figures
Tables
| Values | Normal range | |
|---|---|---|
| Calcium (mg/dL) | 11.8 | 8.5 - 10.5 |
| Phosphorus (mg/dL) | 3.0 | 2.5 - 4.5 |
| Parathyroid hormone (pg/mL) | 154 | 12 - 65 |
| 24 h urine calcium (mg/24h) | 170 | 112 - 353 |
| Prolactin (ng/mL) | 6.49 | < 20.3 |
| Insulin growth factor 1 (ng/mL) | 141 | 75 - 212 |
| Gastrin (pg/mL) | 10 | 13 - 115 |
| Chromogranin A (U/mL) | 101.6 | Up to 100 |
| 5-hydroxyindoleacetic acid (mg/24h) | 2.7 | 2 - 9 |
| Author | Age | Sex | Symptoms | EGDS | Size of gastrinoma in biliary tree (cm) | KI-67 | Biliary tree gastrinoma localization | Other endocrine neoplasms | Therapeutical approach for MEN 1 | Metastasis | Time of follow-up free of cancer (months) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| aZollinger-Ellison syndrome. bTwo out of 31 lymph nodes examined had neuroendocrine tumor tissue positive for gastrin after surgery including the removal of the regional lymph nodes. NA: not available. | |||||||||||
| Price et al [7] | 55 | F | NAa | NAa | 0.6 | NA | Common bile duct, cystic duct | Pituitary adenoma, hyperparathyroidism, non-functioning NET in the pancreas | Distal splenopancreatectomy, radio-frequency ablation hepatic excision bile duct | Liver (solitary) | 24 |
| Price et al [7] | 43 | F | Symptomatic gastroesophageal reflux disease | NA | 1.5 × 1.2 × 0.1 | NA | Common bile duct | Pituitary adenoma, hyperparathyroidism, non-functioning NET in the pancreas, duodenal gastrinoma | Pylorus preserving duodenopancreatectomy, enucleation, gastric excision | Lymph nodes (common bile duct) | 24 |
| Lee et al [8] | 39 | F | Abdominal pain, nausea, and vomiting; history of spontaneous perforation of the duodenum | NA | 1.6 × 1.5 × 0.9 | NA | Liver (II-III segment) | Pituitary macroadenoma, hyperparathyroidism, insulinoma | Whipple’s duodenopancreatectomy, II-III liver segmentectomy | No | 12 |
| Tonelli et al [3] | 46 | F | Recurrent renal colic episodes; epigastralgia | Ulceration of the first and second portions of the duodenum | 1.2 | < 1% | Bile duct | Hyperparathyroidism, non-functioning NET in the pancreas, duodenal, gastrinoma | Total parathyroidectomy, total pancreatectomy with gastroduodenal resection and splenectomy, bile duct resection | No | 1 |
| Tonelli et al [3] | 55 | F | Kidney stones with recurrent renal colic; episodes of epigastric pain | Duodenal ulcer | 0.2 | < 1% | Gallbladder fundus | Hyperparathyroidism, non-functioning NET in the pancreas, duodenal gastrinoma | Total parathyroidectomy, with a parathyroid autograft in the non-dominant forearm, Whipple’s duodenopancreatectomy | No | NA |
| Tonelli et al [3] | 37 | F | Heartburn, abdominal pain and diarrhea | Esophagitis and gastroduodenitis with peptic ulcers | 1.5 | < 1% | Bile duct | Non-functioning NET of the pancreas, duodenal gastrinoma | Pylorus-preserving duodenopancreatectomy extended to the pancreatic body, with removal of the regional lymph nodes and the gallbladder, hepatic resection (V-VIII segment) and enucleation of a pancreatic head nodule | Lymph nodesb | NA |
| Our case | 65 | F | Mesogastric pain; chronic diarrhea, steatorrhea, weight loss | Reflux esophagitis, erosive antral gastritis, duodenitis bulbar and pyloric deformity | 1.0 | < 2% | Cystic duct | Hyperparathyroidism | Cholecystectomy | No | 24 |