Primary lymph node gastrinoma. A diagnosis of exclusion. A case for duodenotomy in the setting of a negative imaging for primary tumor: A case report and review of the literature

Annabelle Teng, Christopher Haas, David Y. Lee, John Wang, Edward Lung, Fadi Attiyeh

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

INTRODUCTION Zollinger-Ellison syndrome (ZES) is caused by uninhibited secretion of gastrin from a gastrinoma. Gastrinomas most commonly arise within the wall of the duodenum followed by the pancreas. Primary lymph node gastrinomas have also been reported in the literature. This is a case of ZES where preoperative localization revealed a gastrinoma in a solitary portacaval lymph node, presumed to be a primary lymph node gastrinoma.

PRESENTATION OF CASE The patient is a 57 year old female diagnosed with ZES, suspected of having a primary lymph node gastrinoma. The patient underwent an exploratory laparotomy and excision of a portacaval lymph node with a frozen section which was positive for gastrinoma. Intraoperative sonography of the pancreas, upper endoscopy with transillumination of the duodenum, and a duodenotomy with bimanual examination of the duodenal wall were also performed. The patient was found to have a 4 mm duodenal mass near the pylorus, which was excised.

DISCUSSION Pathology showed that the duodenal mass was primary gastrinoma. Serum gastrin levels taken four months postoperatively were normal and the repeat octreotide scan did not show any evidence of recurrence.

CONCLUSION Primary lymph node gastrinoma is a diagnosis of exclusion. The duodenum and pancreas must be fully explored to rule out a primary gastrinoma that may be occult.

Original languageEnglish
Pages (from-to)849-852
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume5
Issue number11
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Duodenotomy
  • Duodenum
  • Gastrinoma
  • Pancreas
  • Zollinger-Ellison syndrome

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