Chen Yufei, Deshpande Vikram, Ferrone Cristina, Blaszkowsky Lawrence S, Parangi Sareh, Warshaw Andrew L, Lillemoe Keith D, Fernandez-Del Castillo Carlos
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Department of Pathology, Massachusetts General Hospital, Boston, MA.
Surgery. 2017 Nov;162(5):1088-1094. doi: 10.1016/j.surg.2017.05.017. Epub 2017 Jul 10.
Gastrinomas are rare neuroendocrine tumors that ectopically secrete gastrin and classically originate within the duodenum or pancreas. The presence of primary lymph node gastrinoma is controversial. We report on a single institution's experience with gastrinoma, with focus on primary lymph node tumors.
Patients who underwent operative resection of gastrinoma between 1992 and 2016 at a single institution were identified. A diagnosis of primary lymph node gastrinoma was defined as tumor confined to one or more resected peripancreatic lymph nodes, negative localization for any extra-nodal disease and normal gastrin postresection.
In the study, 39 consecutive patients underwent operative resection of gastrinoma. Mean age was 53 years and 49% were male. 93% of patients had successful preoperative localization. Furthermore, 19 patients (49%) underwent enucleation of their tumor and 14 (35.9%) a pancreatic resection. Overall 5- and 10-year survival for all patients was 80.8% and 60.7%, respectively. Primary lymph node gastrinoma was identified in 11 cases (28.2%). The presentation of primary lymph node and non-primary lymph node patients were similar. There was no significant difference in operation type, tumor size, or overall survival. At median follow-up of 59 months, patients with primary lymph node gastrinoma were less likely to have persistent or recurrent disease (9.1% vs 42.9%, P = .04).
This series supports the existence of primary lymph node gastrinomas, and indicates that as many as 1 in 4 patients with gastrinoma have this form of the disease. This entity should be considered when an isolated pathologic lymph node is identified, although thorough exploration is still recommended to exclude other occult disease.
胃泌素瘤是一种罕见的神经内分泌肿瘤，可异位分泌胃泌素，通常起源于十二指肠或胰腺。原发性淋巴结胃泌素瘤的存在存在争议。我们报告了一家机构胃泌素瘤的治疗经验，重点是原发性淋巴结肿瘤。
确定1992年至2016年在一家机构接受胃泌素瘤手术切除的患者。原发性淋巴结胃泌素瘤的诊断定义为肿瘤局限于一个或多个切除的胰腺周围淋巴结，无任何淋巴结外疾病定位且切除后胃泌素正常。
在该研究中，39例连续患者接受了胃泌素瘤手术切除。平均年龄为53岁，49%为男性。93%的患者术前定位成功。此外，19例患者（49%）行肿瘤剜除术，14例（35.9%）行胰腺切除术。所有患者的总体5年和10年生存率分别为80.8%和60.7%。11例（28.2%）患者被诊断为原发性淋巴结胃泌素瘤。原发性淋巴结和非原发性淋巴结患者的表现相似。手术类型、肿瘤大小或总体生存率无显著差异。在中位随访59个月时，原发性淋巴结胃泌素瘤患者持续性或复发性疾病的可能性较小（9.1%对42.9%，P = 0.04）。
本系列研究支持原发性淋巴结胃泌素瘤的存在，并表明多达四分之一的胃泌素瘤患者患有这种疾病形式。当发现孤立的病理性淋巴结时，应考虑这一实体，尽管仍建议进行全面探查以排除其他隐匿性疾病。
