Spontaneous Regression Of Gastric Gastrinoma After Resection Of Metastases To The Lesser Omentum: A Case Report And Review Of Literature
Okamoto, T., Yoshimoto, T., Ohike, N., Fujikawa, A., Kanie, T., & Fukuda, K. (2021). Spontaneous regression of gastric gastrinoma after resection of metastases to the lesser omentum: A case report and review of literature. World journal of gastroenterology, 27(1), 129–142. https://doi.org/10.3748/wjg.v27.i1.129
View Original Source →Abstract
BACKGROUND: Gastric gastrinoma and spontaneous tumor regression are both very rarely encountered. We report the first case of spontaneous regression of gastric gastrinoma. CASE SUMMARY: A 37-year-old man with a 9-year history of chronic abdominal pain was referred for evaluation of an 8 cm mass in the lesser omentum discovered incidentally on abdominal computed tomography. The tumor was diagnosed as grade 2 neuroendocrine neoplasm (NEN) on endoscopic ultrasound-guided fine-needle aspiration. Screening esophagogastroduodenoscopy revealed a 7 mm red polypoid lesion with central depression in the gastric antrum, also confirmed to be a grade 2 NEN. Laparoscopic removal of the abdominal mass confirmed it to be a metastatic gastrinoma lesion. The gastric lesion was subsequently diagnosed as primary gastric gastrinoma. Three months later, the gastric lesion had disappeared without treatment. The patient remains symptom-free with normal fasting serum gastrin and no recurrence of gastrinoma during 36 mo of follow-up. CONCLUSION: Gastric gastrinoma may arise as a polypoid lesion in the gastric antrum. Spontaneous regression can rarely occur after biopsy.
Case Details
Disease Location
Stomach
Personal Characteristics
37-year-old man, history of gastric mucosal erosions diagnosed 9 years prior to admission. The patient had chronic abdominal pain and occasional reflux symptoms despite continued treatment with proton pump inhibitors (ppis).
Clinical Characteristics
Presented to the emergency department after a sudden cardiopulmonary arrest. Return of spontaneous circulation was achieved due to bystander cardiopulmonary resuscitation and 2 electric shocks from an automated external defibrillator. CT with contrast at admission revealed an incidental 8 cm mass in the lesser omentum. The mass appeared to result from the fusion of 3 similar solid tumors, of which 1 contained a non-enhancing, low-density area suggestive of necrosis or hematoma. Esophagogastroduodenoscopy (egd) incidentally revealed a red, 7 mm submucosal tumor with central depression, which was biopsied. Pathology of both the gastric and lesser omentum specimens stained positive for chromogranin a and synaptophysin and were diagnosed as grade 2 neuroendocrine neoplasm (nens). Laparoscopic omental tumor resection with possible gastrectomy was planned
Remission Characteristics
Follow-up egd 3 months later, the gastric gastrinoma had reduced to a red dot with no visible elevation and was barely identifiable. Biopsy of the lesion was negative for tumor, with only regenerative and fibrous changes. Chromogranin a and synaptophysin stains were also negative
Treatment & Mechanisms
Proposed Remission Mechanisms
Biopsy of the primary lesion and subsequent surgery triggered the spontaneous regression.
Clinical Treatment
Biopsy, laparoscopy