The long-term follow up of the patient with gastrinoma — the diagnostics and therapeutics problems

Abstract

Gastrinomas are well differentiated neuroendocrine neoplasms. About fifty percent of patients present with liver and lymph nodes metastases at the time of diagnosis.

46 years old woman with abdominal pain and diarrhea. In computed tomography (CT) performed in 2005 tumor of the hiatus of the spleen was revealed. Intraoperatively tumor of the pancreatic tail was found. Patient underwent distal pancreatectomy with splenectomy. Histopathological examination confirmed gastrinoma. There were no pathological findings on imaging examinations till 2007. Somatostatin receptor scintigraphy (SRS) performed in 2007 revealed pathological focal uptake in the 6th segment of the liver and increased uptake of the tracer in segments 2 and 7. CT confirmed the presence of the lesion in the 6th segment. Due to dissemination of the disease and positive result of SRS patient underwent peptide receptor radionuclide therapy (PRRT). Thereafter therapy with long-acting somatostatin analogue was started. Remission of the disease observed in SRS and CT lasts for five after PRRT. Due to the presence of the new metastatic lesion in the liver patient underwent thermal ablation of the lesion. The latter ultrasound examination revealed few small (less than 1 cm in diameter) lesions in the liver — further imaging examinations are planned.

Presented case shows long time course of the disease in a patient with gastrinoma. We would like to emphasize the necessity of the use of different, usually complementary, imaging methods. We wanted also to present differ­ent, also usually complementary, therapeutic options in case of such a patients.