title: Case of primary hepatic gastrinoma: Diagnostic usefulness of the selective arterial calcium injection test.
abstract: Gastrinomas mainly occur in the duodenum and pancreas. Primary hepatic gastrinoma is rare and difficult to diagnose because the liver is a frequent site of metastatic gastrinomas. Clinical factors were assessed in a 28-year-old man with diarrhea and heartburn who was hospitalized for recurrent duodenal ulcers. Abdominal ultrasound, endoscopic ultrasound and computed tomography (CT) could not detect a tumor in the duodenum or pancreas. His gastrin level was 846 pg/mL and magnetic resonance imaging showed a mass 12 mm in diameter in the right robe of the liver. A selective intra-arterial calcium injection (SACI) test and 68-gallium edotreotide positron emission tomography CT (Ga-DOTATOC PET-CT) were therefore performed. Calcium gluconate injection into the proper hepatic artery resulted in a marked increase in serum gastrin concentration in the right hepatic vein, with Ga-DOTATOC PET-CT showing uptake only by the liver mass. Following a diagnosis of primary hepatic gastrinoma, the tumor was resected. A histopathological examination indicated gastrinoma. Six months postoperatively, he has no symptoms, is not taking proton-pump inhibitors and his gastrin level remains within the normal range. The SACI test and the clinical course of this patient strongly suggest that the tumor was a primary hepatic gastrinoma. The SACI test is helpful in the diagnosis of primary hepatic gastrinoma.
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Satoshi
authors.identifier: http://orcid.org/0000-0003-4970-4212
authors.initials: S
authors.lastname: Ogawa
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Wada
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukushima
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Shimeno
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Hobyung
authors.initials: H
authors.lastname: Chung
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Suginoshita
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okada
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Inokuma
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Department of Radiology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Kyo
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
keywords: Zollinger-Ellison syndrome; gastrinoma; liver; selective arterial calcium injection test