title: Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?
abstract: Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma. Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization. Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured. Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.
authors.affiliation: Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, 79106 Freiburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jaenigen
authors.forename: Gian
authors.initials: G
authors.lastname: Kayser
authors.forename: Berthold
authors.initials: B
authors.lastname: Steinke
authors.forename: Oliver
authors.initials: O
authors.lastname: Thomusch