Hopethe Hubbard, MD; Richard Goodgame, MD

Disclosures

February 13, 2007

Discussion and Conclusion

Most patients with a sporadic gastrinoma present with symptoms of ZES. About 25% of these tumors are not localized preoperatively, even using a combination of CT scan, MRI, somatostatin receptor scintigraphy, EUS, and angiography. Although most sporadic gastrinomas are malignant, many patients have small intraduodenal tumors without metastases; these represent the majority of tumors that are not imaged preoperatively. The exact natural history of such patients is not known. If such patients undergo operation with intent to cure, careful palpation, intraoperative ultrasound exam, and modern operative techniques, tumor identification and resection may occur in up to 76% of patients. However, operation may still fail to identify a tumor in at least 7% of patients.[6]

In patients who have undergone surgical resection, the 10-year survival rate for those without hepatic metastases is 94%-96% for tumors measuring < 2 cm and 86%-91% for tumors > 2 cm. About one third of patients are completely disease-free at 10 years. For those patients who have negative laparotomy, the precise natural history remains unknown. The best means of follow-up in these cases is also unknown. It is likely that our patient has a small intraduodenal gastrinoma. Surgery, if performed, may be curative; but the patient must be aware that there is a small chance that even operation will not identify the source of the gastrinoma.

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