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Gastrinoma

Gastrinomas are the second most common pancreatic islet cell tumour.

Epidemiology

Most gastrinomas are sporadic, although some are seen in the setting of  with multiple endocrine neoplasia type I (MEN I). In general these present in young adults 1

Clinical presentation

Due to the physiological action of gastrin, resulting in excessive secretion of acid into the stomach, initial manifestations is with peptic ulcer disease (PUD) with multiple recurrent and intractable ulcers, often in unusual locations. This constellation of findings due to a gastrinoma is known as Zollinger-Ellison syndrome.

Diarrhoea due to the large volume of hydrochloric acid and a direct effect of gastrin on the small bowel is also common.

Radiographic features

General

Gastinomas are usually malignant and as they are frequently multiple and often extrapancreatic (90% located in the gastrinoma triangle) they can be difficult to locate. As such multiphase contrast enhanced thin slice cross-sectional imaging is ideal. 

Tumour size is variable, but pancreatic lesions average 3-4 cm.

The lesions are often hypervascular, so they may be visible on arterial phase CT and angiography.

Treatment and prognosis

Hepatic metastases are associated with a poor prognosis, whereas patients with metastases isolated to lymph nodes often have long-term survival.

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