title: Nonfunctioning pancreatic endocrine tumor presenting with hemorrhage from isolated gastric varices.
abstract: Hemorrhage from gastric varices due to left-sided portal hypertension is an unusual presentation for pancreatic endocrine tumor. A case of pancreatic endocrine tumor presenting with gastric variceal hemorrhage secondary to left-sided portal hypertension associated with splenic vein occlusion is presented. A 53-year-old man with hemorrhage from isolated gastric varices was referred to our hospital. Laboratory studies revealed normal liver function. Surveys to identify the cause of gastric varices by an abdominal CT, MRCP, and abdominal angiography revealed splenic vein occlusion secondarily attributed to the pancreatic tail tumor and splenomegaly. The pancreatic tumor was suspected to be a resectable endocrine tumor. A distal pancreatectomy, splenectomy, partial resection of the gastric fundus, and limited lymph node dissection were performed. By the histological examination, the diagnosis of nonfunctioning pancreatic endocrine tumor with malignant potential was determined. Three years after the surgery, the patient is doing well and reveals no sign of recurrence. In this case, the unusual presentation for pancreatic endocrine tumors such as a gastric variceal hemorrhage had an advantage that led to early presentation prior to the development of metastases with possible curative surgery.
authors.affiliation: Department of Surgery, Rakuwakai-Otowa Hospital, Kyoto, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Ryuzaburo
authors.initials: R
authors.lastname: Kagawa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Takeda
authors.forename: Shingo
authors.initials: S
authors.lastname: Sakata
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Iwasa
mesh_terms: D007516:Adenoma, Islet Cell / Q000175:diagnosis* / Q000601:surgery; D001707:Biopsy, Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000628:therapy; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D013156:Splenectomy / Q000379:methods; D013162:Splenic Vein / Q000503:physiopathology; D016896:Treatment Outcome