Okada Kenjiro, Sudo Takeshi, Miyamoto Katsunari, Yokoyama Yujiro, Sakashita Yoshihiro, Hashimoto Yasushi, Kobayashi Hironori, Otsuka Hiroyuki, Sakoda Takuya, Shimamoto Fumio
Hiroshima J Med Sci. 2016 Mar;65(1):13-7.
The localization and diagnosis of microgastrinomas in a patient with multiple endocrine neoplasia type 1 is difficult preoperatively. The selective arterial calcium injection (SACI) test is a valid diagnostic method for the preoperative diagnosis of these invisible microgastrinomas. We report a rare case of multiple invisible duodenal microgastrinomas with severe duodenal stenosis diagnosed preoperatively by using the SACI test. A 50-year-old man was admitted to our hospital with recurrent duodenal ulcers. His serum gastrin level was elevated to 730 pg/ml. It was impossible for gastrointestinal endoscopy to pass through to visualize the inferior part of the duodenum, because recurrent duodenal ulcers had resulted in severe duodenal stenosis. The duodenal stenosis also prevented additional endoscopic examinations such as endoscopic ultrasonography. Computed tomography did not show any tumors in the duodenum and pancreas. The SACI test provided the evidence for a gastrinoma in the vascular territory of the inferior pancreatic-duodenal artery. We diagnosed a gastrinoma in the peri- ampullary lesion, so we performed Subtotal Stomach-Preserving Pancreatico- duodenectomy with regional lymphadenectomy. Histopathological findings showed multiple duodenal gastrinomas with lymph node metastasis and nonfunctioning pancreatic neuroendocrine tumors. Twenty months after surgery, the patient is alive with no evidence of recurrence and a normal gastrin level. In conclusion, the SACI test can enhance the accuracy of preoperative localization and diagnosis of invisible microgastrinomas, especially in the setting of severe duodenal stenosis.
1型多发性内分泌肿瘤患者术前对微胃泌素瘤进行定位和诊断很困难。选择性动脉钙注射（SACI）试验是术前诊断这些隐匿性微胃泌素瘤的有效诊断方法。我们报告了1例罕见的隐匿性十二指肠微胃泌素瘤伴严重十二指肠狭窄的病例，术前通过SACI试验得以诊断。一名50岁男性因复发性十二指肠溃疡入院。其血清胃泌素水平升高至730 pg/ml。由于复发性十二指肠溃疡导致严重十二指肠狭窄，胃肠内镜无法通过以观察十二指肠下部。十二指肠狭窄也妨碍了诸如内镜超声等进一步的内镜检查。计算机断层扫描未显示十二指肠和胰腺有任何肿瘤。SACI试验为胰十二指肠下动脉血管区域存在胃泌素瘤提供了证据。我们诊断壶腹周围病变为胃泌素瘤，因此实施了保留胃的胰十二指肠次全切除术并进行区域淋巴结清扫。组织病理学检查结果显示为多发性十二指肠胃泌素瘤伴淋巴结转移及无功能性胰腺神经内分泌肿瘤。术后20个月，患者存活，无复发迹象，胃泌素水平正常。总之，SACI试验可提高术前对隐匿性微胃泌素瘤定位和诊断的准确性，尤其是在严重十二指肠狭窄的情况下。
