Gastrinomas are the second most common sporadic pancreatic islet cell tumour and most common type in the setting of multiple endocrine neoplasia type I (MEN I).
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.
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.
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.
- pancreatic neoplasms
- cystic neoplasm (cystic pancreatic mass differential diagnosis)
- solid neoplasm
- gallstone pancreatitis
- interstitial oedematous pancreatitis
- necrotising pancreatitis
- international multidisciplinary classification of acute pancreatitis severity
- subacute pancreatitis
- chronic pancreatitis
- Ascaris-induced pancreatitis
- autoimmune pancreatitis
- emphysematous pancreatitis
- haemorrhagic pancreatitis
- hereditary pancreatitis
- pancreatitis associated with cystic fibrosis
- segmental pancreatitis
- acute pancreatitis
- pancreatic atrophy
- pancreatic lipomatosis
- pancreatic trauma
- 1. Demos TC, Posniak HV, Harmath C et-al. Cystic lesions of the pancreas. AJR Am J Roentgenol. 2002;179 (6): 1375-88. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Yu J, Fulcher AS, Turner MA et-al. Normal anatomy and disease processes of the pancreatoduodenal groove: imaging features. AJR Am J Roentgenol. 2004;183 (3): 839-46. AJR Am J Roentgenol (citation) - Pubmed citation
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