Natural history of gastrinoma: lessons from the past.
Factors affecting natural history of gastrinoma (Zollinger-Ellison Syndrome) are not yet entirely understood, although much valid information has been gained in the last two decades. Prognostic factors are: a) adequate reduction of gastric acid overproduction insuring symptomatic control and healing of ulcerative lesions; b) inclusion in multiple endocrine neoplasia-1 syndrome rendering gastrinoma surgery rarely indicated and scarcely efficacious; c) size location and spread of the tumoural process(es) conditioning resectability and risk of metachronous liver and extra-abdominal metastases; d) hepatic and bone metastases, major determinants of death; e) development of paraneoplastic Cushing rapidly out of control and causing death within a short period of time; f) development of fundic EC-Lomas in Zollinger-Ellison Syndrome-multiple endocrine neoplasia-1 patients, generally undergoing benign course but possibly leading to lymph node and (exceptionally) to liver metastases and, sometimes, to total gastrectomy; g) experience of medical and surgical teams which are also most important in order to achieve no operative mortality and minimal post-operative complications.
Mignon
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Hôpital Bichat Claude Bernard, Paris, France. michel.mignon@bch.ap-hop-paris.fr
Cadiot
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D000328:Adult; D017677:Age Distribution; D003480:Cushing Syndrome / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D015408:Gastrinoma / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000556:secondary; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000209:etiology / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D015043:Zollinger-Ellison Syndrome / Q000401:mortality / Q000473:pathology