Abstract
Carcinoids are neuroendocrine tumours which may secrete hormones like gastrin, insulin, ACTH, etc. Liver is a common site for metastasis of carcinoid origin and an unusual site for a primary carcinoid tumour to arise.We present the case of a 51-year-old Caucasian man with diarrhoea, weight loss, duodenum ulcers and a liver mass in ultrasonography. A primary hepatic carcinoid tumour with a Zollinger Ellison syndrome was diagnosed. Surgery resection was performed and the patient remained free of symptoms two years after, with normalisation of gastrin levels.Primary hepatic carcinoid tumour represents an uncommon diagnosis, based on radiological and pathological features. The exclusion of different primary locations is necessary. Once associated with a Zollinger Ellison syndrome, diagnose may be more complicated and challenging since only 7 cases of hepatic carcinoids with gastrin secretion were reported in medical literature.A review of medical literature is performed and diagnoses tools that should be used for an accurate diagnosis and available treatment approaches are commented here.
Highlights
Gastrin is predominantly produced by G cells of the gastric antrum and plays two major roles in the gastrointestinal physiology: (i) stimulation of gastric acid secretion and (ii) secondly as a trophic hormone for epithelial and enterochromaffin cells growth [1,2]
Liver is a common site for metastasis of carcinoid origin and an unusual site for a primary carcinoid tumour to arise
Gastrinomas are usually associated with the Zollinger Ellison syndrome (ZES) which is characterized by multiple peptic ulcers and severe diarrhoea with inflammatory, osmotic or malabsorptive features due to the excessive acidification of the duodenum and the lower small bowel [2]
Summary
Gastrin is predominantly produced by G cells of the gastric antrum and plays two major roles in the gastrointestinal physiology: (i) stimulation of gastric acid secretion and (ii) secondly as a trophic hormone for epithelial and enterochromaffin cells growth [1,2]. The symptoms began 11 years ago and were intermittent and mostly nocturnal He worsened 3 months before admission with exacerbation of number of deposition, abdominal pain and weight loss. He was on PPI therapy on demand and at high doses for pyrosis. Abdominal ultrasound revealed a liver mass in the 2nd and 3rd segment of a 10 x 8 cm diameter and small bowel distension. A PET study was performed which showed high abnormal uptake in the liver mass as well as a diffuse uptake into the axils, small bowel wall and spleen. Upper endoscopy revealed no duodenum ulcers and his serum gastrin levels decreased till 19 pg/ml two months after surgery. The patient remained free of symptoms two years after surgery
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