[A rare combination of pheochromocytoma ans somatostatin-rich neuroendocrine tumor of Vater's papilla (carcinoid) in a patient with von Recklinghausen neurofibromatosis].
A 74-year-old male suffering from Recklinghausen's fibromatosis (NvR) is reported. He presented with weight loss, cholestasis, endocrine and exocrine pancreatic insufficiency. These symptoms were caused by a neuroendocrine tumor of the ampulla of Vater containing somatostatin. The tumor induced an obstruction of both the common bile and the pancreatic duct. In addition to this uncommon tumor, a silent pheochromocytoma was found. The patient was treated by endoscopic papillotomy, substitution of pancreatic enzymes and additional enteral nutrition. After recovery no progression of the disease was observed over one year. A review of the literature shows that patients with neurofibromatosis are at high risk for periampullar tumors. In particular, somatostatin-rich carcinoids were previously documented. Pheochromocytomas are also quite prevalent in NvR. However the combination of NvR, pheochromocytoma and somatostatin-rich neuroendocrine tumors of the duodenum has only been reported a few times. An explanation for the high prevalence of neuroendocrine tumors in NvR might be the loss of neurofibromin, a tumor suppressor protein, which is the main product of the neurofibromatosis-l-gene.
Hardt
P D
PD
Medizinische Klinik III und Poliklinik der Justus-Liebig-Universität Giessen.
Doppl
W E
WE
Klör
H U
HU
Hinrichs
B
B
D000368:Aged; D014670:Ampulla of Vater; D002276:Carcinoid Tumor / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D002779:Cholestasis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D003937:Diagnosis, Differential; D004750:Enteral Nutrition; D006801:Humans; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy; D009456:Neurofibromatosis 1 / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D010166:Palliative Care; D010184:Pancreatic Extracts / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D013004:Somatostatin / Q000378:metabolism*; D016717:Sphincterotomy, Endoscopic
D010184:Pancreatic Extracts; D013004:Somatostatin
Die seltene Kombination eines Phäochromozytoms und eines somatostatinreichen neuroendokrinen Tumors der Papilla Vateri (Karzinoid) bei einem Patienten mit Neurofibromatose von Recklinghausen (NvR).