DUODENAL MICROGASTRINOMAS ASSOCIATED WITH ZOLLINGER-ELLISON SYNDROME

This report describes 4 cases of duodenal microgastrinomas associated with a Zollinger-Ellison syndrome. All gastrinomas were solitary tumor s located in the submucosal layer of the first (n = 3) or second porti on (n = 1) of the duodenum. The tumor size ranged from 0.75 to 8 mm in diameter (mean 4.9 mm). All gastrinomas were classified as malignant with respect to the metastatic spread to regional lymphnodes (n = 4) a nd liver (n = 1). None of the gastrinomas was identified by the preope rative imaging studies. Three tumors were localized during the surgica l exploration, one tumor (0.75 mm in diameter) by the histopathologica l work-up of the resected specimen. The surgical therapy included two local resections and two Whipple procedures. Except for the patient wi th hepatic metastases the postoperative serum gastrin was normal indic ating complete tumor resection. No patient died because of recurrent o r metastastic gastrinoma. In conclusion, microgastrinomas of the duode num are rarely diagnosed preoperatively because of their small size bu t can be identified by careful surgical exploration. Considering the h igh malignancy rate of this tumor patient prognosis depends on radical surgical therapy.