World Journal of Surgery

, Volume 16, Issue 4, pp 703–709 | Cite as

Clinicopathological characteristics of duodenal microgastrinomas

  • Masayuki Imamura
  • Masahiro Kanda
  • Kiyoyuki Takahashi
  • Yutaka Shimada
  • Tokiharu Miyahara
  • Takashi Wagata
  • Mitsuaki Hashimoto
  • Takayoshi Tobe
  • Jun Soga
Article

Abstract

Duodenal gastrinomas do not seem to behave as malignantly as sporadic pancreatic gastrinomas. Statistical analysis of 49 patients with sporadic pancreatic gastrinoma and 21 patients with sporadic duodenal gastrinoma reported since 1980 in Japan revealed that the incidence of hepatic metastasis was 57% in patients with sporadic pancreatic gastrinoma and only 9% in patients with sporadic duodenal gastrinoma (p<0.01). These findings suggest that there is an essential biological differences between duodenal and pancreatic gastrinoma. Five patients with sporadic duodenal microgastrinoma (tumor diameter <5mm) in our hospital had no hepatic metastases; however, 4 patients had lymph node metastases. Immunohistochemical study of 5 sporadic duodenal microgastrinomas and 6 sporadic pancreatic gastrinomas revealed that the sporadic duodenal gastrinomas contained significantly fewer insulin-producing or glucagon-producing cells than sporadic pancreatic gastrinomas. The cellular composition of the metastatic lymph nodes from duodenal microgastrinomas was similar to that of the primary tumor. This difference in cellular composition between the duodenal microgastrinomas and the pancreatic gastrinomas suggests that the process of development and differentiation of gastrinoma cells is different.

Keywords

Lymph Node Metastasis Glucagon Clinicopathological Characteristic Como Metastatic Lymph Node 

Résumé

Les gastrinomes duodénaux (D-Goma) ne semblent pas avoir le même potentiel malin que les gastrinomes pancréatiques sporadiques (P-Goma). L'analyse statistique de 49 cas de P-Goma sporadiques et de 21 cas de D-Goma sporadiques, rapportés depuis 1980 au Japon, a montré que l'incidence des métastases hépatiques était de 57% dans les P-Goma sporadiques et seulement de 9% dans les D-Goma (p<0.01). Ces données suggèrent qu'il existe une différence biologique essentielle entre les D-Goma et les P-Goma. Cinq patients atteints de D-microGoma sporadique (tumeurs <5mm de diamètre) suivis dans notre hôpital n'avaient pas de métastases hépatiques; cependant quatre d'entre eux avaient des métastases ganglionnaires. L'étude immunohistochimique des 5 cas de micro D-Gomas et de 6 cas de P-Gomas sporadiques a montré que les D-Gomas sporadiques contenaient significativement moins de cellules insuline ou glucagon sécrétrices que les P-Gomas sporadiques. La composition cellulaire des métastases ganglionnaires des D-microGomas était comparable à celle de la tumeur primitive. La différence de composition cellulaire entre D-microGoma et P-Goma suggère que le processus de développement et de différentiation des cellules de gastrinomes est différent.

Resumen

Los gastrinomas duodenales (Goma-D) no parecen tener un comportamiento tan maligno como el de los gastrinomas pancreáticos esporádicos (Goma-P). El análisis estadístico de 49 casos de Goma-P esporádico y de 21 casos de Goma-D esporádico reportados desde 1980 en el Japón, reveló que la incidencia de metástasis hepáticas fue de 57% en los Goma-P esporádicos y apenas de 9% en los Goma-D esporádicos (p<0.01), hallazgos que sugieren que existen diferencias biológicas entre los Goma-D y los Goma-P. Cinco pacientes con microGomas-D esporádicos (tumores de<5 mm de diámetro) vistos en nuestro hospital no desarrollaron metástasis hapáticas; sin embargo, cuatro de ellos tenía metástasis ganglionares. El estudio inmunohistoquímico de cinco microGomas-D esporádicos y de seis Gomas-P esporádicos reveló que los Gomas-D esporádicos contenían significativamente menos células productoras de insulina o de glucagón que los Gomas-P esporádicos. La composición celulande los ganglios metástasicos de los Gomas-D apareció similar a la del tumor principal. Tal diferencia en la composición celular entre los microGomas-D y los Gomas-P sugiere que el proceso de desarrollo y diferenciación del gastrinoma es diferente.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Thompson, N.W., Vinik, A.I., Eckhauser, F.E., Stradel, W.E.: Extrapancreatic gastrinomas. Surgery98:1113, 1985PubMedGoogle Scholar
  2. 2.
    Thompson, N.W., Vinik, A.L., Eckhauser, F.E.: Microgastrinomas of the duodenum: A cause of failed operations for the Zollinger-Ellison syndrome. Ann. Surg.209:396, 1989PubMedGoogle Scholar
  3. 3.
    Imamura, M., Takahashi, K., Adachi, H., Minematsu, S., Shimada, H., Naito, M., Suzuki, T., Tobe, T., Azume, T.: Usefulness of selective arterial secretin injection test for localization of gastrinoma in the Zollinger-Ellison syndrome. Ann. Surg.205:230, 1987PubMedGoogle Scholar
  4. 4.
    Doppman, J.L., Miler, D.L., Chang, R., Maton, P.N., London, J.F., Gardner, J.D., Jensen, R.T., Norton, J.A.: Gastrinomas: Localization by means of selective intraarterial injection of secretin. Radiology174:25, 1990PubMedGoogle Scholar
  5. 5.
    Rosato, F.E., Bonn, J., Shapiro, M., Barbot, D.D., Furnary, A.: Selective arterial stimulation of secretin localization of gastrinomas. Surg. Gynecol. Obstet.71:196, 1990Google Scholar
  6. 6.
    Ingemansson, S., Larson, L.-I., Lunderquist, A., Stadil, F.: Pancreatic vein catheterization with gastrin assay in normal patients and in patients with Zoolinger-Ellison syndrome. Am. J. Surg.134:558, 1977PubMedGoogle Scholar
  7. 7.
    Stabile, B.E., Morrow, D.J., Passaro, E. Jr.: The gastrinoma triagle: Operative implications. Am. J. Surg.147:25, 1984PubMedGoogle Scholar
  8. 8.
    Zollinger, R.M.: Gastrinoma: Factors influencing prognosis. Surgery97:49, 1984Google Scholar
  9. 9.
    Oberhelman, H.A. Jr., Nelsen, T.S., Johnson, A.N., Dragstedt, L.R.: Ulcerogenic tumors of the duodenum. Ann. Surg.153:214, 1961PubMedGoogle Scholar
  10. 10.
    Delcore, R., Cheung, L.Y., Friesen, S.R.: Outcome of lymph node involvement in patients with the Zollinger-Ellison syndrome. Ann. Surg.208:291, 1988PubMedGoogle Scholar
  11. 11.
    Vogel, S.B., Wolfe, M.M., McGuigan, J.E.: Localization and resection of gastrinomas in Zollinger-Ellison syndrome. Ann. Surg.205:550, 1987PubMedGoogle Scholar
  12. 12.
    Stabile, B.E., Passaro, E.: Eenign and malignant gastrinomas. Am. J. Surg.149:144, 1985PubMedGoogle Scholar
  13. 13.
    Thom, A.K., Norton, J.F., Axiotis, C.A., Maton, P.N., Jensen, R.T.: Location, incidence and malignant potential of duodenal gastrinomas. Program of The 12th Annual Meeting of American Association of Endocrine Surgeons, California, 1991, pp. 56Google Scholar
  14. 14.
    Imamura, M., Takahashi, K., Isobe, Y., Hattori, Y., Satomura, K., Tobe, T.: Curative resection of multiple gastrinomas aided by selective arterial secretion injection test and intraoperative secretin test. Ann Surg.210:710, 1989PubMedGoogle Scholar
  15. 15.
    Sternberger, L.A.: Immunohistochemistry. Englewood Cliffs, Prentice Hall, 1974, pp. 129–171Google Scholar
  16. 16.
    Nakane, P.K., Pierce, G.B.: Enzyme labeled antibody: Preparation and application for the localization of antigens. J. Histochem. Cytochem.14:291, 1966PubMedGoogle Scholar
  17. 17.
    Oberhelman, H.A. Jr.: Excisional therapy for ulcerogenic tumors of the duodenum: Long term results. Arch. Surg.104:447, 1972PubMedGoogle Scholar
  18. 18.
    Zollinger, R.M.: Treatment of gastrinoma. Mount Sinai J. Med.51:401, 1984Google Scholar
  19. 19.
    Thompson, N.W., Lloyd, R.V., Nishiyama, R.H., Vinik, A.I., Stordel, W.E., Allo, M.D., Eckhauser, F.E., Talpos, G., Mervak, T.: MEN I pancreas: A histological and immunohistological study. World J. Surg.8:561, 1984PubMedGoogle Scholar
  20. 20.
    Stamm, B., Hedinger, C.E., Saremaslani, P.: Duodenal and ampullary carcinoid tumors. Virchows Arch. [Pathol. Anat.]408:475, 1986Google Scholar
  21. 21.
    Arnold, R., Creutzfeldt, C., Creutzfeldt, W.: Multiple hormone production of endocrine tumors of the gastrointestinal tract. In Endocrinology, Vol 2, Oxford, Exerpta Medica, 1977, pp. 448–452Google Scholar
  22. 22.
    Heitz, P.U., Kasper, M., Polak, L.M., Kloppel, G.: Pancreatic endocrine tumors. Hum. Pathol.13:263, 1982PubMedGoogle Scholar
  23. 23.
    Norton, J.F., Colen, M.J., Gardner, J.D., Doppman, J.L., Harmon, J.W., Jensen, R.T., Maton, P.N.: Prospective study of gastrinoma localization and resection in patients with Zollinger-Ellison syndrome. Ann. Surg.204:468, 1986PubMedGoogle Scholar
  24. 24.
    Estes, B.L., Krejs, G.J.: The inhibitory syndrome: Somatostatinoma. In Surgical Endocrinology: Clinical Syndromes, 2nd edition, S.R. Friesen, N.W. Thompson, editors, Philadelphia, Lippincott, 1990, pp. 249–266Google Scholar
  25. 25.
    Taccagni, G.L., Carlucci, M., Sironi, M., Cantaboni, A., Carlo, V.D. Duodenal somatostatinoma with psammoma bodies: An immunological and ultrastructural study. Am. J. Gastroenterol.81:33, 1986PubMedGoogle Scholar

Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Masayuki Imamura
    • 3
    • 1
    • 2
  • Masahiro Kanda
    • 3
    • 1
    • 2
  • Kiyoyuki Takahashi
    • 3
    • 1
    • 2
  • Yutaka Shimada
    • 3
    • 1
    • 2
  • Tokiharu Miyahara
    • 3
    • 1
    • 2
  • Takashi Wagata
    • 3
    • 1
    • 2
  • Mitsuaki Hashimoto
    • 3
    • 1
    • 2
  • Takayoshi Tobe
    • 3
    • 1
    • 2
  • Jun Soga
    • 3
    • 1
    • 2
  1. 1.Department of Pathology, Division of Medical TechnologyKyoto UniversityKyotoJapan
  2. 2.Division of Medical TechnologyNiigata UniversityNiigataJapan
  3. 3.First Department of Surgery, Faculty of MedicineKyoto UniversityKyotoJapan

Personalised recommendations