Carcinoid Syndrome Misdiagnosed as a Malabsorptive Syndrome after Biliopancreatic Diversion
First Online: 06 July 2007 Received: 24 January 2007 Accepted: 29 April 2007 DOI:
10.1007/s11695-007-9157-4 Cite this article as: López-Tomassetti Fernández, E.M., González, I.A., Luis, H.D. et al. OBES SURG (2007) 17: 989. doi:10.1007/s11695-007-9157-4 Abstract
A case is reported of a woman who developed untreatable diarrhea after a prior biliopancreatic diversion (BPD), attributed to the malabsorptive component. Abdominal ultrasound incidentally found focal liver lesions. On fine needle aspiration biopsy, atypia was found, and these hepatic lesions were resected with free margins. The specimen showed liver metastases of an aggressive malignant neuroendocrine neoplasm. The primary site was subsequently identified to be in the pancreas. The physician and surgeon must realize that non-related diseases can develop after bariatric surgery, as in the general population.
Key words Morbid obesity bariatric surgery biliopancreatic diversion neuroendocrine cancer carcinoid syndrome liver metastases cancer References
Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003; 289: 187–93.
Liberopoulos EN, Mikhailidis DP, Elisaf MS. Diagnosis and management of the metabolic syndrome in obesity. Obes Rev 2005; 6: 283–96.
Adami HO, Trichopoulos D. Obesity and mortality from cancer. N Engl J Med 2003; 348: 1623–4.
Alvarez GC, Faria EN, Beck DT et al. Laparoscopic spleen preserving distal pancreatectomy as treatment for nesidioblastosis after gastric bypass surgery. Obes Surg 2007; 17: 550–2.
Valverde I, Puente J, Martin-Duce A et al. Changes in glucagon-like peptide-1 (GLP-1) secretion after biliopancreatic diversion or vertical banded gastroplasty in obese subjects. Obes Surg 2005; 15: 387–97.
Scopinaro N, Gianetta E, Civalleri D et al. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg 1979; 66: 618–20.
Scopinaro N, Adami GF, Marinari GM et al. Biliopancreatic diversion. World J Surg 1998; 22: 936–46.
DeRoover A, Detry O, Desaive C et al. Risk of upper gastrointestinal cancer after bariatric operations. Obes Surg 2006; 16: 1656–61.
Keshishian A, Hamilton J, Hwang L et al. Carcinoid tumor and bariatric surgery. Obes Surg 2002; 12: 874–5.
Service GJ, Thompson GB, Service FJ et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005; 353: 249–54.
Cummings DE. Gastric bypass and nesidioblastosis – too much of a good thing for islets? N Engl J Med 2005; 353: 300–2.
Lamounier RN, Pareja JC, Tambascia MA et al. Incretins: clinical physiology and bariatric surgery – correlating the entero-endocrine system and a potentially anti-dysmetabolic procedure. Obes Surg 2007; 17: 569–76.
Stewart ID, Flaks B, Watanapa P et al. Pancreatobiliary diversion enhances experimental pancreatic carcinogenesis. Br J Cancer 1991; 63: 63–6.
Watanapa P, Efa EF, Beardshall K et al. Inhibitory effect of a cholecystokinin antagonist on the proliferative response of the pancreas to pancreatobiliary diversion. Gut 1991; 32: 1049–51.
Morisset J, Julien S, Laine J. Localization of cholecystokinin receptor subtypes in the endocrine pancreas. J Histochem Cytochem 2003; 51: 1501–13.
Howatson AG, Carter DC. Pancreatic carcinogenesisenhancement by cholecystokinin in the hamster-nitrosamine model. Br J Cancer 1985; 51: 107–14.
Smith JP, Kramer ST, Solomon TE. CCK stimulates growth of six human pancreatic cancer cell lines in serum-free medium. Regul Pept 1991; 32: 341–9.
Reubi JC. CCK receptors in human neuroendocrine tumors: clinical implications. Scand J Clin Lab Invest Suppl 2001; 234: 101–4.
Holdstock C, Engstrom BE, Ohrvall M et al. Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans. J Clin Endocrinol Metab 2003; 88: 3177–83.
Adami GF, Cordera R, Andraghetti G et al. Changes in serum ghrelin concentration following biliopancreatic diversion for obesity. Obes Res 2004; 12: 684–7.
Volante M, Allia E, Gugliotta P et al. Expression of ghrelin and of the GH secretagogue receptor by pancreatic islet cells and related endocrine tumors. J Clin Endocrinol Metab 2002; 87: 1300–8.
Zagury L, Moreira RO, Guedes EP et al. Insulinoma misdiagnosed as dumping syndrome after bariatric surgery. Obes Surg 2004; 14: 120–3.
PubMed CrossRef Copyright information
© Springer Science + Business Media B.V. 2007