Hanzawa Shunya, Sadamori Hiroshi, Kagoura Masaaki, Monden Kazuteru, Hioki Masayoshi, Hyodo Tsuyoshi, Omonishi Kunihiro, Takakura Norihisa
Department of Surgery, Fukuyama City Hospital, 5-23-1 Zao-cho, Fukuyama, Hiroshima, 721-8511, Japan.
Department of Radiology, Fukuyama City Hospital, 5-23-1 Zao-cho, Fukuyama, Hiroshima, 721-8511, Japan.
Surg Case Rep. 2020 Nov 18;6(1):290. doi: 10.1186/s40792-020-01072-9.
A majority of gastrinomas causing Zollinger-Ellison syndrome are located in the duodenum or pancreas. Primary hepatic gastrinomas are rare and difficult to diagnose. We report a rare case of primary hepatic gastrinoma, which could be diagnosed preoperatively.
A 29-year-old man with a 55-mm tumor in segments 5 and 6 (S 5/6) of the liver was admitted to our hospital. After thorough investigations, he was treated for a suspected inflammatory pseudotumor and advised to undergo routine follow-up. Two years later, he revisited our hospital with a complaint of abdominal pain, vomiting, and diarrhea. Upper gastrointestinal endoscopy revealed multiple duodenal ulcers. His serum gastrin level was 2350 pg/mL (normal: 37-172 pg/mL), suggesting Zollinger-Ellison syndrome. Abdominal computed tomography showed a 78-mm hypervascular tumor with cystic degeneration in the S 5/6 region of the liver, with a potential to increase over time. The tumor showed hypointensity on T2-weighted and hyperintensity on diffusion-weighted abdominal contrast-enhanced magnetic resonance imaging. Somatostatin receptor scintigraphy (SRS) only detected a hepatic tumor. No tumors in the gastrinoma triangle were detected by endoscopic ultrasonography. Hence, selective arterial calcium injection (SACI) test was performed to determine the location of the gastrinoma. The serum gastrin concentration increased from 4620 pg/mL to 23,600 pg/mL at 20 s after calcium gluconate injection into the proper hepatic artery. Conversely, no effect on serum gastrin level was observed after the injection into any other arteries. Extended right hepatic lobectomy and cholecystectomy were performed after percutaneous transhepatic portal vein embolization. A histopathological examination of the liver tumor revealed a gastrinoma. The patient's serum gastrin concentration on postoperative day 1 decreased to 65 pg/mL.
We report a surgical case of primary hepatic gastrinoma correctly diagnosed preoperatively. The patient underwent extended right hepatic lobectomy, resulting in a histological definitive diagnosis of primary hepatic gastrinoma.
大多数导致卓-艾综合征的胃泌素瘤位于十二指肠或胰腺。原发性肝胃泌素瘤罕见且难以诊断。我们报告一例罕见的术前可诊断的原发性肝胃泌素瘤病例。
一名29岁男性因肝脏第5和第6段（S 5/6）有一个55毫米的肿瘤入住我院。经过全面检查，他因疑似炎性假瘤接受治疗，并被建议进行常规随访。两年后，他因腹痛、呕吐和腹泻再次就诊我院。上消化道内镜检查发现多个十二指肠溃疡。他的血清胃泌素水平为2350 pg/mL（正常：37 - 172 pg/mL），提示卓-艾综合征。腹部计算机断层扫描显示肝脏S 5/6区域有一个78毫米的高血管性肿瘤伴囊性变，且有随时间增大的可能。该肿瘤在腹部对比增强磁共振成像的T2加权像上呈低信号，在扩散加权像上呈高信号。生长抑素受体闪烁显像（SRS）仅检测到肝脏肿瘤。内镜超声未在胃泌素瘤三角区发现肿瘤。因此，进行了选择性动脉钙刺激试验（SACI）以确定胃泌素瘤的位置。向肝固有动脉注射葡萄糖酸钙后20秒，血清胃泌素浓度从4620 pg/mL升至23600 pg/mL。相反，向其他任何动脉注射后未观察到对血清胃泌素水平有影响。在经皮经肝门静脉栓塞术后进行了扩大右肝叶切除术和胆囊切除术。肝脏肿瘤的组织病理学检查显示为胃泌素瘤。术后第1天患者的血清胃泌素浓度降至65 pg/mL。
我们报告一例术前正确诊断的原发性肝胃泌素瘤手术病例。患者接受了扩大右肝叶切除术，从而对原发性肝胃泌素瘤做出了组织学确诊。
