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Primary lymph node gastrinoma: A single institution experience.

Yufei Chen1, Vikram Deshpande2, Cristina Ferrone1

  • 1Department of Surgery, Massachusetts General Hospital, Boston, MA.

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|July 15, 2017
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Summary

Primary lymph node gastrinomas, a rare neuroendocrine tumor, are confirmed to exist and may account for up to 28% of cases. These tumors show similar presentation but less recurrence than other gastrinomas.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Endocrinology

Background:

  • Gastrinomas are rare neuroendocrine tumors secreting gastrin, typically originating in the duodenum or pancreas.
  • The existence of primary lymph node gastrinoma remains a subject of debate.
  • This study investigates a single institution's experience with gastrinoma, focusing on primary lymph node tumors.

Purpose of the Study:

  • To investigate the incidence and characteristics of primary lymph node gastrinomas.
  • To compare outcomes between patients with primary lymph node gastrinoma and those with other gastrinoma origins.
  • To determine the clinical significance of primary lymph node gastrinomas.

Main Methods:

  • Retrospective review of patients who underwent operative resection of gastrinoma between 1992 and 2016.
  • Definition of primary lymph node gastrinoma: tumor confined to resected peripancreatic lymph nodes, no extra-nodal disease, and normal post-resection gastrin levels.
  • Analysis of patient demographics, surgical procedures, tumor characteristics, and follow-up data.

Main Results:

  • 39 patients underwent gastrinoma resection; 11 (28.2%) had primary lymph node gastrinoma.
  • Presentation, operation type, tumor size, and overall survival were similar between groups.
  • Patients with primary lymph node gastrinoma had significantly lower rates of persistent or recurrent disease (9.1% vs. 42.9%, P = .04).

Conclusions:

  • This study supports the existence of primary lymph node gastrinomas.
  • Primary lymph node gastrinomas may represent up to 25% of all gastrinoma cases.
  • Consider primary lymph node gastrinoma in cases of isolated pathologic lymph nodes, but exclude other occult disease.