Resection of a glucagonoma from the body of the pancreas in a patient with multiple endocrine neoplasia type 1 and a suspected synchronous microgastrinoma in the hepato-pancreaticoduodenal region: a case report

Abstract

A 66-year-old woman with a 25-year history of multiple endocrine neoplasia type 1 presented with left-sided abdominal pain. She was diagnosed with acute pancreatitis, and imaging studies at a local hospital revealed a 3cm tumor in the tail of the pancreas. Further evaluation at our hospital showed elevated serum glucagon (630pg/ml) and gastrin (280pg/ml) levels. A selective arterial calcium injection test suggested a glucagonoma in the tail of the pancreas and a gastrinoma in the hepato-pancreaticoduodenal region. The body and tail of the pancreas was resected to remove the glucagonoma. Computed tomography, magnetic resonance imaging, and endoscopic ultrasound failed to demonstrate any lesion in the pancreas or duodenum, and the patient did not wish to undergo total pancreatectomy/duodenectomy. During three years of postoperative follow-up, the serum gastrin levels in this patient have fluctuated between 150 and 300pg/ml, but there is no evidence of a recurrent glucagonoma or the suspicion of a gastrinoma.