Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Feb;11(1):75-78.
doi: 10.14740/gr955w. Epub 2018 Feb 23.

A Rare Cause of Abdominal Pain and Mass in an 18-Year-Old Patient: A Diagnostic Dilemma

Hassan Tariq  1 , Muhammad Umar Kamal  1 , Vamshidhar Vootla  1 , Mohamed ElZaeedi  2 , Masooma Niazi  3 , Brian Gilchrist  2 , Ariyo Ihimoyan  1 , Anil Dev  1 , Sridhar Chilimuri  1
Affiliations
Case Reports

A Rare Cause of Abdominal Pain and Mass in an 18-Year-Old Patient: A Diagnostic Dilemma

Hassan Tariq et al. Gastroenterology Res. 2018 Feb.

Abstract

We present a case of an 18-year-old male who presented with complains of abdominal pain, nausea and vomiting for 2 years. An esophagogastroduodenoscopy (EGD) revealed a 3 mm nodule on the lesser curvature of the stomach and prominent gastric folds. Biopsy of the nodule revealed a well-differentiated neuroendocrine tumor (NET) in lamina prop with focal extension into muscularis mucosa consistent with a gastric carcinoid. Tumor cells stained with neuron-specific enolase (NSE), chromogranin and synaptophysin only. The prominent gastric fold biopsy revealed gastric fundic mucosa with mucosal edema and focal mild chronic inflammation. Serum gastrin level was found to be 2,083 pg/mL. Abdomen CT and endoscopic ultrasound (EUS) revealed a mass near the pancreatic neck. These findings were consistent with a functional gastrin producing well-differentiated grade 1 neuroendocrine neoplasm (gastrinoma). The patient underwent exploratory laparotomy with resection of the mass and resulting in normalization of gastrin levels.

Keywords: Gastric carcinoids; Gastrinoma; Neuroendocrine tumor; Primary peripancreatic gastrinoma; Zollinger-Ellison syndrome.

PubMed Disclaimer

Conflict of interest statement

None of the authors have any financial conflict of interest.

Figures

Figure 1
Figure 1
A 3 mm nodule on the lesser curvature of the stomach (arrow) (left) and prominent gastric folds (right).
Figure 2
Figure 2
A well-differentiated neuroendocrine tumor in lamina propria with focal extension into muscularis mucosa consistent with a gastric carcinoid (hematoxylin and eosin stain, magnification: left × 40, right × 100).
Figure 3
Figure 3
Octreotide scan showing abnormal uptake in the stomach consistent with a large gastric carcinoid without any evidence of metastatic disease (left). A computed tomography (CT) scan of abdomen and pelvis with contrast showed a lobulated soft tissue mass in the mid upper abdomen inseparable from inferior part of the liver and lesser curvature of the stomach (right).
Figure 4
Figure 4
Macroscopic picture of peripancreatic mass with a lobulated cut surface. The mass was adherent to the lesser curve of stomach and anterior surface of pancreas.
Figure 5
Figure 5
Histology of peripancreatic gastrinoma. Upper left (hematoxylin and eosin stain, please provide magnification). Immunohistochemistry revealed that the tumor cells are positive for chromogranin (upper mid), synaptophysin upper right) and gastrin (lower right) but negative for insulin (lower mid). Immunostain showed < 2% of tumor cells to be positive for Ki-67 (lower right).
See this image and copyright information in PMC

References

    1. Fraenkel M, Kim MK, Faggiano A, Valk GD. Epidemiology of astroenteropancreatic neuroendocrine tumours. Best practice & research Clinical gastroenterology. 2012;26:691–703. doi: 10.1016/j.bpg.2013.01.006. - DOI - PubMed
    1. Ito T, Igarashi H, Nakamura K, Sasano H, Okusaka T, Takano K, Komoto I. et al. Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis. J Gastroenterol. 2015;50(1):58–64. doi: 10.1007/s00535-014-0934-2. - DOI - PubMed
    1. Huang SF, Kuo IM, Lee CW, Pan KT, Chen TC, Lin CJ, Hwang TL. et al. Comparison study of gastrinomas between gastric and non-gastric origins. World J Surg Oncol. 2015;13:202. doi: 10.1186/s12957-015-0614-6. - DOI - PMC - PubMed
    1. Borch K, Ahren B, Ahlman H, Falkmer S, Granerus G, Grimelius L. Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg. 2005;242(1):64–73. doi: 10.1097/01.sla.0000167862.52309.7d. - DOI - PMC - PubMed
    1. Epelboym I, Mazeh H. Zollinger-Ellison syndrome: classical considerations and current controversies. Oncologist. 2014;19(1):44–50. doi: 10.1634/theoncologist.2013-0369. - DOI - PMC - PubMed

Publication types

LinkOut - more resources