Exp Clin Endocrinol Diabetes 2007; 115 - N7
DOI: 10.1055/s-2007-990420

Lymph node gastrinoma in multiple endocrine neoplasia type 1– a diagnostic challenge

K Muessig 1, M Wehrmann 2, M Horger 3, R Bares 4, HU Haering 1, B Gallwitz 1, S Petersenn 5
  • 1Division of Endocrinology, Diabetology, Nephrology, Angiology and Clinical Chemistry, Department of Internal Medicine
  • 2Department of General Pathology
  • 3Department of Diagnostic Radiology
  • 4Department of Nuclear Medicine, University Hospital of Tuebingen, Germany
  • 5Division of Endocrinology, Medical Center, University of Essen, Germany

We report on the difficulty to differentiate between metastatic and primary lymph node gastrinoma in a 62-year-old female patient with multiple endocrine neoplasie type 1 (MEN1). At six and twelve months after resection of a retroduodenal lymph node gastrinoma, no signs of recurrence of gastrinoma were observed. Basal and peak gastrin levels during secretin test were normalized. An extensive exploration, including gastrointesinal endoscopy, endoscopic ultrasonography, and Ga-68-DOTATOC-PET/CT, did not reveal a primary duodenal or pancreatic tumour. Localization of gastrinomas in patients with MEN1 is challenging due to their small size, frequent duodenal location, and multiplicity. Therefore, primary lymph node gastrinoma remains an exclusion diagnosis and extensive follow-ups are required.