Apparent lymph node primary gastrinoma.
BACKGROUND
The existence of lymph node (LN) primary gastrinoma as a cause of Zollinger-Ellison syndrome is controversial. We reviewed our experience with patients in whom gastrinomas were identified and excised only from LNs.


METHODS
From 1982 to 1992, 110 patients with ZES underwent exploration for gastrinoma and 21 (19%) had disease limited to one or more LNs. Standardized exploration included intraoperative ultrasonography, intraoperative endoscopy with transillumination and exploratory duodenotomy in 86%, 67%, and 24% of patients, respectively. Each patient underwent yearly biochemical and radiologic follow-up.


RESULTS
Thirteen patients (62%) with a median follow-up period of 5.8 years had an initial biochemical cure, whereas eight patients (38%) with a median follow-up period of 3.6 years had persistent disease. Of the 13 patients whose condition initially returned to normal, four have had biochemical recurrence, with a median time to recurrence of 4.2 years and a median follow-up period of 7.4 years. Nine patients (43%) remain biochemically cured, with a median follow-up period of 5.3 years.


CONCLUSIONS
Resection of apparent LN primary gastrinoma is warranted, because 43% of those who underwent resection had no evidence of disease, with a median follow-up period of 5.3 years.
Arnold
W S
WS
Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, Md 20892.
Fraker
D L
DL
Alexander
H R
HR
Weber
H C
HC
Norton
J A
JA
Jensen
R T
RT
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015408:Gastrinoma / Q000601:surgery*; D006801:Humans; D008198:Lymph Nodes; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D015043:Zollinger-Ellison Syndrome / Q000601:surgery