Immunohistochemical assessment of an asymptomatic glucagonoma in a patient with hypergastrinemia and marked antral angiodysplasia.
A 58-year-old patient had been treated for recurrent gastritis. Numerous gastroscopies indicated hemorrhagic gastritis combined with increasingly severe anemia. The patient was admitted with a hemoglobin of 4.4 g/dL. Gastroscopy showed marked antral angiodysplasia. Serum samples for gastrin were taken and found to be elevated (170-250 U/mL). The search for a gastrin-producing tumor with abdominal ultrasound, computed tomography, octreotide scan, and secretin test was negative, but angiography detected a pancreas tumor with a 2-cm diameter. Partial pancreatectomy and partial gastrectomy were performed. Immunohistochemical examination of the tumor did not show a gastrinoma but did show glucagon-reactive tissue. Further tumors or elevated plasma hormone levels were not detected, and a multiple endocrine neoplasia type I syndrome could be excluded. We thus found antral angiodysplasia with hypergastrinemia leading to detection of a glucagonoma diagnosed by immunohistochemistry. After more than 4 years of follow-up, the patient is without any symptoms or signs of relapse or secondary hormone syndrome.
Department of Medicine I,  Institute of Pathology, Landeskliniken Salzburg, Austria, EU.
R
R
Weitgasser
P
P
Sungler
C
C
Hauser-Kronberger
O
O
Dietze
P
P
Sattlegger
G W
GW
Hacker
D003937:Diagnosis, Differential; D020252:Gastric Antral Vascular Ectasia / Q000209:etiology* / Q000473:pathology; D005755:Gastrins / Q000097:blood*; D005934:Glucagon / Q000378:metabolism; D005935:Glucagonoma / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000175:diagnosis; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D011706:Pyloric Antrum / Q000473:pathology
D005755:Gastrins; D005934:Glucagon