Honda Munehiro, Ishibashi Miyuki
Fourth Dept. of Medicine, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213-8507, Japan.
Gan To Kagaku Ryoho. 2004 Mar;31(3):337-41.
The gastroenteropancreatic endocrine tumor is relatively rare tumor that originate from pancreas, duodenum, and a variety of neuroendocrine cells. The differential diagnosis and preoperative localization of the tumor are important, because surgical resection of the tumor is the first choice of treatment. Of these tumors, insulinomas and gastrinomas are usually small in size (less than 2.0 cm), and methods of preoperative localization such as ultrasonography, computed tomography or magnetic resonance imaging often fail to identify them. These tumors often malignant, and tumors as small as 1 to 2 mm might develop lymph node metastases especially in gastrinomas. Recent studies have shown that selective arterial calcium stimulation test and hepatic venous sampling using intraarterial calcium injection as the insulin secretagogue are useful for detection of small insulinomas, and the selective intraarterial injection of secretin test combined with venous sampling (Imamura technique), for detection of small gastrinomas. In addition, somatostatin-receptor scintigraphy is widely used in Western countries. Moreover, detection of the tumor during operation using ultrasonography delivered much better results than preoperative diagnoses. These tumors may be associated with multiple endocrine neoplasia type 1, and MEN1 gene mutation analysis is necessary in those patients.
胃肠胰内分泌肿瘤是一种相对罕见的肿瘤，起源于胰腺、十二指肠和多种神经内分泌细胞。肿瘤的鉴别诊断和术前定位很重要，因为手术切除肿瘤是首选的治疗方法。在这些肿瘤中，胰岛素瘤和胃泌素瘤通常体积较小（小于2.0厘米），术前定位方法如超声检查、计算机断层扫描或磁共振成像常常无法识别它们。这些肿瘤往往是恶性的，小至1至2毫米的肿瘤可能会发生淋巴结转移，尤其是胃泌素瘤。最近的研究表明，选择性动脉钙刺激试验以及使用动脉内注射钙作为胰岛素促分泌剂的肝静脉采血，对于检测小胰岛素瘤很有用，而选择性动脉内注射促胰液素试验联合静脉采血（今村技术），则用于检测小胃泌素瘤。此外，生长抑素受体闪烁扫描术在西方国家被广泛应用。而且，术中使用超声检查检测肿瘤比术前诊断效果要好得多。这些肿瘤可能与1型多发性内分泌肿瘤相关，对于那些患者，有必要进行MEN1基因突变分析。
