Kimura Akie, Nebiki Hiroko, Yamaguchi Nanako, Hirata Naoto, Suekane Takehisa, Yamasaki Tomoaki, Miura Koutarou, Murata Akihiro, Fukushima Hiroko, Inoue Takeshi
Department of Gastroenterology, Osaka City General Hospital.
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2020;117(8):706-712. doi: 10.11405/nisshoshi.117.706.
A 42-year-old man, after remission of MALT lymphoma of the small intestine, was repeatedly hospitalized because of abdominal pain and severe dehydration caused by frequent vomiting and watery diarrhea. His symptoms would improve quickly every time when he was fasted and inserted a nasogastric tube. We were unable to find abnormalities on endoscopic examination and computed tomography. He was suspected to have gastrinoma because of active bleeding from a duodenal ulcer. High-level serum gastrin, endoscopic ultrasound, somatostatin receptor scintigraphy, and selective arterial calcium injection test were done. He was diagnosed with pancreatic gastrinoma in the pancreatic head by endoscopic ultrasound fine needle aspiration and subsequently underwent pancreatoduodenectomy. Histopathologic findings showed a 3-mm neuroendocrine tumor located in the duodenal submucosal layer. The presence of metastasis was confirmed in one of the peripancreatic lymph nodes. The pancreatic gastrinoma in the pancreatic head that we initially diagnosed was a lymph node metastasis behind the pancreas. Because additional resection was performed on the duodenum, we were able obtain a diagnosis of duodenal gastrinoma.
一名42岁男性，小肠黏膜相关淋巴组织淋巴瘤缓解后，因频繁呕吐和水样腹泻导致腹痛及严重脱水而反复住院。每次禁食并插入鼻胃管后，他的症状都会迅速改善。在内镜检查和计算机断层扫描中，我们未发现异常。因十二指肠溃疡活动性出血，怀疑他患有胃泌素瘤。进行了高血清胃泌素水平检测、内镜超声检查、生长抑素受体闪烁扫描及选择性动脉钙刺激试验。通过内镜超声细针穿刺，他被诊断为胰头胃泌素瘤，随后接受了胰十二指肠切除术。组织病理学检查发现一个3毫米的神经内分泌肿瘤位于十二指肠黏膜下层。在胰周淋巴结之一中证实存在转移。我们最初诊断的胰头胃泌素瘤实际上是胰腺后方的淋巴结转移瘤。由于对十二指肠进行了额外切除，我们得以确诊为十二指肠胃泌素瘤。
