Takasu A, Shimosegawa T, Fukudo S, Asakura T, Uchi M, Kimura K, Kashimura J, Satoh K, Koizumi M, Sasaki I, Hongo M, Suzuki T, Toyota T
Third Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
J Gastroenterol. 1998 Oct;33(5):728-33. doi: 10.1007/s005350050163.
Duodenal gastrinoma is recognized as a relatively common cause of Zollinger-Ellison syndrome, but its clinical and biological features are not well known. Here we report a case of duodenal gastrinoma with lymph node metastasis which was confirmed by pathology examinations. Hypergastrinemia and gastric acid hypersecretion were documented, but the secretin test showed negative results. An enlarged peripancreatic lymph node lying close to the pancreas head was the only positive finding on preoperative imaging studies. The results of the selective arterial secretin injection (SASI) test suggested that the primary tumor was located in the gastrinoma triangle. Finally, surgical exploration was carried out and a submucosal tumor, approximately 15 mm in size, was detected by intraoperative palpation at the posterior wall of the proximal portion of the duodenum. Intraoperative pathology examination demonstrated metastases to regional lymph nodes. The present case calls attention to the unique features of duodenal gastrinomas, which differ from those of pancreatic origin: a highly malignant potential for its small size, and submucosal location in the proximal duodenum. The SASI test is recommended for assessing the location of a primary lesion if it cannot be identified by various conventional imaging studies.
十二指肠胃泌素瘤被认为是卓-艾综合征相对常见的病因，但其临床和生物学特征尚不为人熟知。在此，我们报告一例经病理检查确诊的伴有淋巴结转移的十二指肠胃泌素瘤病例。记录到高胃泌素血症和胃酸分泌过多，但促胰液素试验结果为阴性。术前影像学检查的唯一阳性发现是位于胰头附近的胰周肿大淋巴结。选择性动脉内注射促胰液素（SASI）试验结果提示原发肿瘤位于胃泌素瘤三角区。最后进行了手术探查，术中触诊在十二指肠近端后壁发现一个大小约15毫米的黏膜下肿瘤。术中病理检查显示区域淋巴结转移。本病例提醒人们关注十二指肠胃泌素瘤的独特特征，这些特征与胰腺起源的胃泌素瘤不同：体积小但恶性潜能高，且位于十二指肠近端的黏膜下。如果通过各种传统影像学检查无法确定原发灶的位置，推荐使用SASI试验来评估其位置。
