Zollinger-Ellison syndrome

Case contributed by Kareem Mohamed
Diagnosis almost certain

Presentation

Chronic abdominal pain, weight loss, suspected inflammatory bowel disease

Patient Data

Age: 15 years
Gender: Male

CASE OF THE MONTH: This case was selected as the Case of the Month for September 2023.

ct

A well-defined soft tissue mass lesion seen at the gastric bed inseparable from the pancreatic body.

The stomach shows moderate thickening of the gastric folds (rugae).

Biopsy of the mass revealed well-differentiated neuroendocrine tumor while the gastric mucosal biopsy revealed chronic non-active gastritis with no mucosal atrophy.

Biopsy of the mass revealed well-differentiated neuroendocrine tumor while the gastric mucosal biopsy revealed chronic non-active gastritis with no mucosal atrophy.

Case Discussion

The location of the tumor combined with the histopathology result of neuroendocrine tumor are highly suggestive of gastrinoma. The gastrinoma triangle is a well-known concept in radiology and refers to the area that should be searched for in suspected cases.

The combination of neuroendocrine tumor and gastric rugae thickening leads to the diagnosis of Zollinger-Ellison syndrome; that entity was also suggested in the histopathology report due to lack of atrophic changes in the stomach.

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