ABSTRACT
Duodenal neuroendocrine tumors (NETs) comprise 2-3% of all GI endocrine tumors and are increasing in frequency. These include gastrinomas, somatostatinomas, nonfunctional NETs, gangliocytic paragangliomas, and poorly differentiated NE carcinomas. Although, the majority are nonfunctional, these tumors are a frequent cause of Zollinger-Ellison syndrome and can cause other clinical hormonal syndromes (carcinoid, Cushing's, etc.). In this chapter, their epidemiology, clinical aspects, localization, diagnosis and medical treatment are reviewed including the latest advances in each area.
Subject(s)
Carcinoid Tumor/therapy , Duodenal Neoplasms/classification , Duodenal Neoplasms/epidemiology , Neuroendocrine Tumors/classification , Neuroendocrine Tumors/epidemiology , Adult , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle , Carcinoid Tumor/classification , Carcinoid Tumor/epidemiology , Combined Modality Therapy , Duodenal Neoplasms/therapy , Duodenoscopy/methods , Female , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Neoplasm Staging , Neuroendocrine Tumors/therapy , Prognosis , Risk Assessment , Sex Distribution , Somatostatinoma/classification , Somatostatinoma/epidemiology , Somatostatinoma/therapy , Survival Analysis , United States/epidemiology , Zollinger-Ellison Syndrome/classification , Zollinger-Ellison Syndrome/epidemiology , Zollinger-Ellison Syndrome/therapyABSTRACT
Under analysis there were data of 37 patients with the Zollinger-Ellison syndrome (ZES), 36 of them were operated upon. Gastrinomas were found in 21 patients, in 7 of them they were undoubtedly malignant. No tumors were found during operation in 15 patients operated upon with obvious clinical picture of ZES. Treatment of patients with ZES must be differentiated, the patients must be divided into several groups. The idea of "final operation" is substantiated. It can include enucleation of gastrinoma, resection of the pancreas, truncal vagotomy with antrumectomy and sometimes a removal of the stomach or its stump if there had been a resection of the stomach, i.e. a removal of the "target-organ". The necessary succession of medical measures and choice of the operation volume are substantiated in the two given schemes of algorithms with explanations on the basis of personal experiences with treatment of 37 patients with ZES.
Subject(s)
Zollinger-Ellison Syndrome/surgery , Algorithms , Humans , Surgical Procedures, Operative , Zollinger-Ellison Syndrome/classificationABSTRACT
Se presenta un paciente de 43 años con un gastrinoma. Se destacan sus características clínicas, biológicas e histopatológicas; así como la conducta terapéutica realizada. Por último hacemos énfasis en los "apudomas" reseñando sus características, localizaciones y formas de presentaciones con singular interés en el gastrinoma y el síndrome de Zollinger-Ellison del cual se señalan sus aspectos fundamentales y clasificación(AU)
Subject(s)
Humans , Adult , Gastrinoma/therapy , Zollinger-Ellison Syndrome/classificationABSTRACT
The report describes a case of a four-month-old infant, who developed acute gastric ulcer while being hospitalised because of pneumonia. One year's observation of the patient, additional tests, especially gastroscopy with histopathological evaluation of biopsy specimen, determination of gastrin level in blood serum, and therapy analysis allow to establish a diagnosis of pseudo Zollinger-Ellison syndrome.
Subject(s)
Gastric Mucosa/pathology , Gastrointestinal Hemorrhage/etiology , Stomach Diseases/etiology , Stomach Ulcer/complications , Stomach Ulcer/diagnosis , Zollinger-Ellison Syndrome/diagnosis , Edema , Gastrins/blood , Humans , Infant , Male , Stomach Diseases/pathology , Stomach Ulcer/pathology , Zollinger-Ellison Syndrome/classification , Zollinger-Ellison Syndrome/complicationsABSTRACT
The paper discusses data on 48 cases of Zollinger-Ellison's syndrome. Surgery was performed in 45 patients and ulcerated tumor (UT) found in 32. Tumor was detected in the pancreas (17 cases), duodenum, stomach, liver and parapancreatic fat tissue. Multiple tumors were detected in 3 patients. Twenty-seven percent of UT were genuinely or suspiciously malignant. A histological and clinical classification of gastrin-secreting neoplasms is presented. Surgical treatment for Zollinger-Ellison's syndrome presenting with UT and the results of surgery are discussed.
Subject(s)
Zollinger-Ellison Syndrome/etiology , Adult , Aged , Duodenal Neoplasms/classification , Duodenal Neoplasms/etiology , Duodenal Neoplasms/pathology , Duodenal Neoplasms/surgery , Humans , Liver Neoplasms/classification , Liver Neoplasms/etiology , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Middle Aged , Neoplasms, Multiple Primary/classification , Neoplasms, Multiple Primary/etiology , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Pancreatic Neoplasms/classification , Pancreatic Neoplasms/etiology , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Stomach Neoplasms/classification , Stomach Neoplasms/etiology , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Zollinger-Ellison Syndrome/classification , Zollinger-Ellison Syndrome/pathology , Zollinger-Ellison Syndrome/surgerySubject(s)
Endocrine System Diseases/diagnosis , Pancreatic Neoplasms/diagnosis , Carcinoid Tumor/classification , Carcinoid Tumor/diagnosis , Carcinoid Tumor/physiopathology , Cushing Syndrome/classification , Cushing Syndrome/diagnosis , Cushing Syndrome/physiopathology , Endocrine System Diseases/classification , Endocrine System Diseases/physiopathology , Glucagonoma/classification , Glucagonoma/diagnosis , Glucagonoma/physiopathology , Humans , Insulinoma/classification , Insulinoma/diagnosis , Insulinoma/physiopathology , Pancreatic Neoplasms/classification , Pancreatic Neoplasms/physiopathology , Somatostatinoma/classification , Somatostatinoma/diagnosis , Somatostatinoma/physiopathology , Vipoma/classification , Vipoma/diagnosis , Vipoma/physiopathology , Zollinger-Ellison Syndrome/classification , Zollinger-Ellison Syndrome/diagnosis , Zollinger-Ellison Syndrome/physiopathologyABSTRACT
An assessment of treatment methods for the Zollinger-Ellison syndrome over 25 years suggests that the dual surgical approach of excision of resectable tumor and total gastrectomy provides the greatest possibility of attaining tumor and serum gastrin control. Normal serum gastrin levels and reduction of tumor status, not observed with nonoperative management, were attained by surgical treatment, particularly when the tumor (or hyperplasia) was limited to the pancreas, stomach, duodenum and regional lymph nodes. Eleven of 16 such operations resulted in tumor control, and 10 of these patients developed normal serum gastrin concentrations. In elective clinical situations combined medical and surgical therapy is a rational approach allowing confirmation of diagnosis and safe, definitive surgical control of the syndrome before metastases occur.