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Novel association of duodenal gastrinoma and atrophic gastritis: case report and literature review.
Endocr Pract. 2007 Nov-Dec; 13(7):770-5.EP

Abstract

OBJECTIVE

To describe a patient with a duodenal gastrinoma in a setting of atrophic gastritis and hypergastrinemia.

METHODS

We present historical features and results of laboratory and genetic evaluation in a woman with duodenal gastrinoma and hypergastrinemia due to atrophic gastritis.

RESULTS

In a 46-year-old woman with a history of stable pituitary microprolactinoma, multiple gastrointestinal symptoms developed and prompted the performance of an esophagogastroduodenoscopy in conjunction with small bowel biopsies. A 2-mm duodenal gastrin-producing neuroendocrine tumor was discovered. The tumor stained negative for serotonin and somatostatin and involved the mucosa and submucosa. Immunohistochemical staining of the gastrinoma tissue with a monoclonal antibody to the cholecystokinin-B (gastrin) receptor was negative. The patient's random serum gastrin level was elevated at 990 pg/mL. She had been taking pantoprazole for 4 weeks before that test. After pantoprazole therapy was discontinued, the serum gastrin level remained elevated at 403 pg/mL. There was no family history of multiple endocrine neoplasia type 1, and genetic testing for the MEN1 mutation was negative. An upper endoscopy with measurement of gastric pH and performance of gastric biopsies confirmed the presence of chronic atrophic gastritis. This finding was consistent with the patient's persistently elevated serum gastrin levels.

CONCLUSION

Patients with atrophic gastritis and associated hypergastrinemia are known to have a high frequency of hypergastrinemia-induced gastric carcinoid tumors, some of which are actual gastrinomas or are thought to arise from the G cells of the stomach. Gastrin is a well-recognized growth factor for many tissues. We postulate that hypergastrinemia in this patient might have had a trophic effect on the duodenal G cells and led to gastrinoma development. No gastrin receptors were detected on the gastrinoma cells; however, that result might have been attributable to technical (fixation or antibody) or tumor (dedifferentiation) problems.

Authors+Show Affiliations

Divisionof Endocrinology, Diabetes, and Metabolism, The Penn State Milton S.Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

18194935

Citation

Lendel, Irina, et al. "Novel Association of Duodenal Gastrinoma and Atrophic Gastritis: Case Report and Literature Review." Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 13, no. 7, 2007, pp. 770-5.
Lendel I, Manni A, Ruggiero FM. Novel association of duodenal gastrinoma and atrophic gastritis: case report and literature review. Endocr Pract. 2007;13(7):770-5.
Lendel, I., Manni, A., & Ruggiero, F. M. (2007). Novel association of duodenal gastrinoma and atrophic gastritis: case report and literature review. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 13(7), 770-5.
Lendel I, Manni A, Ruggiero FM. Novel Association of Duodenal Gastrinoma and Atrophic Gastritis: Case Report and Literature Review. Endocr Pract. 2007 Nov-Dec;13(7):770-5. PubMed PMID: 18194935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Novel association of duodenal gastrinoma and atrophic gastritis: case report and literature review. AU - Lendel,Irina, AU - Manni,Andrea, AU - Ruggiero,Francesca M, PY - 2008/1/16/pubmed PY - 2008/2/8/medline PY - 2008/1/16/entrez SP - 770 EP - 5 JF - Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists JO - Endocr Pract VL - 13 IS - 7 N2 - OBJECTIVE: To describe a patient with a duodenal gastrinoma in a setting of atrophic gastritis and hypergastrinemia. METHODS: We present historical features and results of laboratory and genetic evaluation in a woman with duodenal gastrinoma and hypergastrinemia due to atrophic gastritis. RESULTS: In a 46-year-old woman with a history of stable pituitary microprolactinoma, multiple gastrointestinal symptoms developed and prompted the performance of an esophagogastroduodenoscopy in conjunction with small bowel biopsies. A 2-mm duodenal gastrin-producing neuroendocrine tumor was discovered. The tumor stained negative for serotonin and somatostatin and involved the mucosa and submucosa. Immunohistochemical staining of the gastrinoma tissue with a monoclonal antibody to the cholecystokinin-B (gastrin) receptor was negative. The patient's random serum gastrin level was elevated at 990 pg/mL. She had been taking pantoprazole for 4 weeks before that test. After pantoprazole therapy was discontinued, the serum gastrin level remained elevated at 403 pg/mL. There was no family history of multiple endocrine neoplasia type 1, and genetic testing for the MEN1 mutation was negative. An upper endoscopy with measurement of gastric pH and performance of gastric biopsies confirmed the presence of chronic atrophic gastritis. This finding was consistent with the patient's persistently elevated serum gastrin levels. CONCLUSION: Patients with atrophic gastritis and associated hypergastrinemia are known to have a high frequency of hypergastrinemia-induced gastric carcinoid tumors, some of which are actual gastrinomas or are thought to arise from the G cells of the stomach. Gastrin is a well-recognized growth factor for many tissues. We postulate that hypergastrinemia in this patient might have had a trophic effect on the duodenal G cells and led to gastrinoma development. No gastrin receptors were detected on the gastrinoma cells; however, that result might have been attributable to technical (fixation or antibody) or tumor (dedifferentiation) problems. SN - 1934-2403 UR - https://www.unboundmedicine.com/medline/citation/18194935/Novel_association_of_duodenal_gastrinoma_and_atrophic_gastritis:_case_report_and_literature_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1530-891X(20)45274-7 DB - PRIME DP - Unbound Medicine ER -