gastro-2017-scientifictracks-abstracts

10 / 42

Page 36
Notes:
conferenceseries.com
Volume 7, Issue 3 (Suppl) J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X Gastro 2017
June 12-13, 2017
June 12-13, 2017 Rome, Italy
11th Global
GastroenterologistsMeeting
Duodenalgastrinomaassociatedwithmultipleendocrineneoplasiatype1detectedbyesophagogastroduodenoscopy
which was buried under ulcer
Kenji Sasaki
Home Medical Care Supporting Clinic Sendai, Japan
A66-year-old Japanese male was shown to have severe ulcers with hypergastrinemia in the stomach through proximal horizontal
part of the duodenum. He suffered from gastric ulcer at 63 and hyperparathyroidism at his 5th decade. Though he had no
definitely enlarged pituitary detectable by computed tomography, he had slight defects in the visual field and hyperprolactinemia.
A diagnosis of multiple endocrine neoplasia type 1 (MEN1) was entertained. Follow up EGD revealed five small sessile submucosal
tumors (SMTs) with a central depression or erosion in the duodenal bulb through descending part of the duodenum, which had
been obscured beneath ulcers. Demonstrated in the regenerative mucosa by biopsy were clusters of small tumor cells, which, though
considered the tips of neuroendocrine (NE) tumor (NET) in the deeper layer, were not large enough to be proven so by immuno
staining with the markers in the serial sections, and diffuse hyperplasia of synaptophysin-, chromogranin A- and gastrin-positive
NE cells in brunner glands (BGs), the preneoplastic lesion characteristic of MEN1-associated duodenal gastrinoma, supporting
the diagnosis, which was firmly guaranteed by positively elevated glucagon-provoked plasma gastrin. Subtotal stomach-preserving
pancreaticoduodenectomy established the final diagnosis of duodenal gastrinoma graded G1 associated with MEN1, which were
shown to be tightly contained in the densely conglomerated hyperplastic BGs. Difficulty in endoscopically detecting the NET lies in
the fact that, in addition to its smallness and deep localization, it might be buried under peptic ulcer at a certain stage and that an
attempt to biopsy it is hampered by the densely conglomerated hyperplastic BGs in some cases.
Biography
Kenji Sasaki completed his MD and, as an Immunologist, he completed his PhD at Tohoku University School of Medicine. He was trained at Miyagi Cancer
Center. He is a Board Certified Fellow and Preceptor of Japan Gastroenterological Endoscopy Society, Board Certified Gastroenterologist of Japanese Society of
Gastroenterology, Board Certified Member of the Japanese Society of Internal Medicine and Editorial Board Member of CRIM. He has published several papers on
Gastroenterology in international journals and served as a Reviewer for Journal of Medical Microbiology, Journal of Pharmacology & Pharmacotherapeutics and
Journal of Gastrointestinal & Digestive System.
Kenji Sasaki, J Gastrointest Dig Syst 2017, 7:3(Suppl)
DOI: 10.4172/2161-069X-C1-049