RESUMO
Gastrinomas are neuroendocrine tumors usually located in the duodenum and pancreas, in the context of a Multiple Endocrine Neoplasm and forming a Zollinger-Ellison syndrome. The location of this type of lymph node tumor is extremely unusual and its early diagnosis constitutes a real challenge to be able to establish an adequate treatment and manage the complications that these entail. We present the case of a 64-year-old male patient with a lymph node gastrinoma and whose surgical removal resulted in the immediate remission of the patient's symptoms.
Assuntos
Gastrinoma , Neoplasia Endócrina Múltipla , Neoplasias Pancreáticas , Síndrome de Zollinger-Ellison , Masculino , Humanos , Pessoa de Meia-Idade , Gastrinoma/diagnóstico , Gastrinoma/cirurgia , Gastrinoma/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologia , Síndrome de Zollinger-Ellison/cirurgia , Neoplasia Endócrina Múltipla/patologia , Linfonodos/patologiaRESUMO
El síndrome de Zollinger Ellison es una entidad producto de un tumor neuroendocrino hipersecretor de gastrina, que genera acidez gástrica exagerada. Entre el 60 a 90% de los casos se comparta de forma maligna, se observan nódulos metastásicos en 50 a 67% de los casos, y se localizan principalmente en el denominado triángulos de los gastrinomas. Los métodos de imagen convencionales poseen poca sensibilidad en la detección de éstas lesiones, sobre todo para las menores a 1 cm. La endosonografía conjunto a la cintilografía de receptores de Somatostatina, son los métodos de imagen estándar de oro para diagnosticar estas lesiones. Presentamos el caso de un paciente masculino de 57 años, que consultó con pancreatitis aguda, enfermedad ulceropéptica y diarrea, a quien se detectó y estadió una lesión única mediante endosonografía, recibió tratamiento quirúrgico de forma exitosa...
Zollinger-Ellison syndrome is a disorder caused by a gastrin hypersecretory neuroendocrine tumor which produces severe gastric acidity. In 60% to 90% of the cases it`s malignant; metastatic nodules are observed in 50% to 67% of the cases, and are located primarily in the so called Gastrinoma triangle. The conventional imaging methods have poor sensibility in detecting these lesions, especially for those that are less than 1 cm. The endosonography conjoint with the Somatostatin receptors scintillography are the standard imaging gold methods to diagnose these lesions. We report the case of a male 57 years-old patient who came to consult with acute pancreatitis, peptic ulcer disease and diarrhea. By endosonography we detected and staged a single lesion. He received surgical treatment successfully...
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Gastrinoma/complicações , Gastrinoma/diagnóstico , Gastrinoma/patologia , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/etiologia , Síndrome de Zollinger-Ellison/patologia , Diagnóstico por Imagem , Endoscopia do Sistema Digestório , GastroenterologiaAssuntos
Gastrinas/sangue , Omeprazol/uso terapêutico , Pepsinogênios/sangue , Úlcera Péptica/tratamento farmacológico , Administração Oral , Biópsia , Pré-Escolar , Endoscopia Gastrointestinal , Feminino , Humanos , Infusões Intravenosas , Omeprazol/administração & dosagem , Úlcera Péptica/sangue , Úlcera Péptica/patologia , Antro Pilórico/patologia , Síndrome de Zollinger-Ellison/sangue , Síndrome de Zollinger-Ellison/tratamento farmacológico , Síndrome de Zollinger-Ellison/patologiaAssuntos
Adulto , Humanos , Feminino , Neoplasias Pancreáticas/cirurgia , Síndrome de Zollinger-Ellison , Gastrectomia , Antagonistas dos Receptores Histamínicos/uso terapêutico , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologia , Procedimentos Cirúrgicos OperatóriosRESUMO
A 61 years old male with Z-E syndrome is reported. He presented gastrointestinal bleeding, abdominal pain, slightly elevated gastrin and hypoglycemia. He underwent total gastrectomy, a non-resectable tumor of the tail of the pancreas with liver metastasis were found. A biopsy of the liver metastasis and the gastric mucosa were reviewed under the light and the transmission electronic microscopes. The gastric mucosa showed abundant parietal cells. The metastatic hepatic tissue was poorly differentiated under the light microscope and the electron micrographs revealed tissue resembling pancreatic islands of Langerhans with granules in the cytoplasm, this means that the neoplasm originated from APUD cells.
Assuntos
Apudoma/patologia , Síndrome de Zollinger-Ellison/patologia , Mucosa Gástrica/patologia , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Síndrome de Zollinger-Ellison/complicaçõesRESUMO
A patient with pancreatic islet cell carcinoma metastatic to the liver developed Zollinger-Ellison syndrome. She presented hypoglycemic crisis afterwards, which were consequent to insulin excess. After streptozotocin treatment, she remained free of symptoms during the following 12 months.
Assuntos
Adenoma de Células das Ilhotas Pancreáticas/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Estreptozocina/uso terapêutico , Síndrome de Zollinger-Ellison/tratamento farmacológico , Adenoma de Células das Ilhotas Pancreáticas/patologia , Avaliação de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Neoplasias Hepáticas/patologia , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Pancreáticas/patologia , Síndrome de Zollinger-Ellison/patologiaRESUMO
A Zollinger-Ellison syndrome case is reported. During arteriography and surgical treatment islet cell carcinoma of the pancreas with metastasis to the liver was found. After surgery, patient has presented several periods of hypoglicemia. Hence it was speculated that this type of neoplasm might have double endocrine function.