Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review
Abstract Background 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. Case presentation A...
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| Language: | English |
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Japan Surgical Society
2020-11-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-01072-9 |
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| author | Shunya Hanzawa Hiroshi Sadamori Masaaki Kagoura Kazuteru Monden Masayoshi Hioki Tsuyoshi Hyodo Kunihiro Omonishi Norihisa Takakura |
| author_facet | Shunya Hanzawa Hiroshi Sadamori Masaaki Kagoura Kazuteru Monden Masayoshi Hioki Tsuyoshi Hyodo Kunihiro Omonishi Norihisa Takakura |
| author_sort | Shunya Hanzawa |
| collection | DOAJ |
| description | Abstract Background 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. Case presentation 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. Conclusion 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. |
| format | Article |
| id | doaj-art-0aa4596650524ef8b6cf99275d38684d |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-0aa4596650524ef8b6cf99275d38684d2025-08-20T03:32:51ZengJapan Surgical SocietySurgical Case Reports2198-77932020-11-01611910.1186/s40792-020-01072-9Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature reviewShunya Hanzawa0Hiroshi Sadamori1Masaaki Kagoura2Kazuteru Monden3Masayoshi Hioki4Tsuyoshi Hyodo5Kunihiro Omonishi6Norihisa Takakura7Department of Surgery, Fukuyama City HospitalDepartment of Surgery, Fukuyama City HospitalDepartment of Surgery, Fukuyama City HospitalDepartment of Surgery, Fukuyama City HospitalDepartment of Surgery, Fukuyama City HospitalDepartment of Radiology, Fukuyama City HospitalDepartment of Pathology, Fukuyama City HospitalDepartment of Surgery, Fukuyama City HospitalAbstract Background 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. Case presentation 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. Conclusion 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.http://link.springer.com/article/10.1186/s40792-020-01072-9Primary hepatic gastrinomaZollinger–Ellison syndromeSelective arterial calcium injection testSomatostatin receptor scintigraphy |
| spellingShingle | Shunya Hanzawa Hiroshi Sadamori Masaaki Kagoura Kazuteru Monden Masayoshi Hioki Tsuyoshi Hyodo Kunihiro Omonishi Norihisa Takakura Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review Surgical Case Reports Primary hepatic gastrinoma Zollinger–Ellison syndrome Selective arterial calcium injection test Somatostatin receptor scintigraphy |
| title | Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review |
| title_full | Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review |
| title_fullStr | Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review |
| title_full_unstemmed | Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review |
| title_short | Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review |
| title_sort | primary hepatic gastrinoma being diagnosed preoperatively a case report and literature review |
| topic | Primary hepatic gastrinoma Zollinger–Ellison syndrome Selective arterial calcium injection test Somatostatin receptor scintigraphy |
| url | http://link.springer.com/article/10.1186/s40792-020-01072-9 |
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