[Scintigraphy with 111In-octreotide in a case of primary hepatic gastrinoma]

Gastrinomas are uncommon tumors which are difficult to locate. They are often located in the head of the pancreas. About two-thirds of them are malignant, their growth is slow and they usually metastasize in the liver. In about 25% of cases, the Zollinger-Ellison (Z-E) syndrome is included in the multiple endocrine neoplasm type 1 syndrome (MEN 1).A 14-year old male patient presenting an episode of abdominal perforation which required emergency surgery is reported. The abdominal ultrasonography, CT scan and magnetic resonance revealed a single lesion in the left liver lobe, suggesting metastasis. Significantly increased levels of serum gastrin suggested a diagnosis of Z-E syndrome. A study with 111In-octreotide was required to locate the primary tumor and evaluate its extent. The scintigraphy showed only one abnormal uptake focus in the left liver lobe. Post-surgery scintigraphy studies revealed the presence of metastatic adenopathies which were removed after a second surgery. No pathologic findings were observed in the last nuclear medicine study. The somatostatin receptor scintigraphy is the most sensitive method to locate primary gastrinomas and to assess the tumoral dissemination in patients with Z-E Syndrome.