CLINICAL-FEATURES OF DUODENAL SOMATOSTATINOMAS

Background. Duodenal somatostatinomas are rare tumors that are often a symptomatic or present with local symptoms rather than with evidence o f excess somatostatin production. To characterize the clinical present ation and management of these neoplasms we reviewed the course of four patients. Methods. The records of three men and one woman with duoden al somatostatinomas, who were treated between 1988 and 1992, are revie wed. Results. Three of the patients presented with vague gastrointesti nal complaints, and one was free of symptoms. No patient had symptoms of somatostatinoma syndrome, nor did any have associated neurofibromat osis. Three patients were diagnosed after biopsy of a submucosal mass during upper endoscopy. Three patients with tumors that measured less than 2 X 2 cm underwent local resection. One patient with a large tumo r and liver metastases underwent a Whipple's operation and resection o f the liver lesions. Immunohistochemically all tumors predominantly co ntained somatostatin, although each had traces of other neuropeptides. All tumors contained psammoma bodies. Follow-up periods ranged from 1 to 4 years. Conclusions. Duodenal somatostatinomas often appear with only local symptoms or are completely asymptomatic. Small tumors may b e locally excised. Intraarterial methylene blue injection may help loc alize very small tumors during operation. Larger tumors, including tho se with localized metastases, should also be resected when possible.