DUODENAL GASTRINOMA - CLINICAL-FEATURES AND USEFULNESS OF SELECTIVE ARTERIAL SECRETIN INJECTION TEST

Duodenal gastrinoma is recognized as a relatively common cause of Zoll inger-Ellison syndrome, but its clinical and biological features are n ot well known. Here we report a case of duodenal,gastrinoma with lymph node metastasis which was confirmed by pathology examinations. Hyperg astrinemia and gastric acid hypersecretion were documented, but the se cretin test showed negative results. An enlarged peripancreatic lymph node lying close to the pancreas head was the only positive finding on preoperative imaging studies. The results of the selective arterial s ecretin injection (SASI) test suggested that the primary tumor was loc ated in the gastrinoma triangle. Finally, surgical exploration was car ried out and a submucosal tumor, approximately 15 mm in size, was dete cted by intraoperative palpation at the posterior wall of the proximal portion of the duodenum. Intraoperative pathology examination demonst rated metastases to regional lymph nodes. The present case calls atten tion to the unique features of duodenal gastrinomas, which differ from those of pancreatic origin: a highly malignant potential for its smal l size, and submucosal location in the proximal duodenum. The SASI tes t is recommended for assessing the location of a primary lesion if it cannot be identified by various conventional imaging studies.