%0 Journal Article
%T Selective Arterial Embolization of Liver Metastases from Gastrinomas: A Single-Centre Experience
%A Anneke P. J. Jilesen
%A Heinz Josef Kl¨¹mpen
%A Olivier R. C. Busch
%A T. M. van Gulik
%A Krijn P. van Lienden
%A Dirk J. Gouma
%A Els J. M. Nieveen van Dijkum
%J ISRN Hepatology
%D 2013
%R 10.1155/2013/174608
%X Background. Gastrinomas are rare functional neuroendocrine tumors causing the Zollinger-Ellison syndrome (ZES). At presentation, up to 25% of gastrinomas are metastasized, predominantly to the liver. Embolization of liver metastases might reduce symptoms of ZES although a postembolization syndrome can occur. In this study, the results of embolization are presented, and the literature results are described. Methods. From a prospective database of pancreatic neuroendocrine tumors, all patients with liver metastatic gastrinomas were selected if treated with arterial embolization. Primary outcome parameters were symptom reduction, complications, and response rate. The literature search was performed with these items. Results. Three patients were identified; two presented with synchronous liver metastases. All the three patients had symptoms of ZES before embolization. Postembolization syndrome occurred in two patients. Six months after embolization, all the 3 patients had a clinical and complete radiological response; a biochemical response was seen in 2/3 patients. From the literature, only a small number of gastrinoma patients treated with liver embolization for liver metastases were found, and similar results were described. Conclusion. Selective liver embolization is an effective and safe therapy for the treatment of liver metastatic gastrinomas in the reduction of ZES. Individual treatment strategies must be made for the optimal success rate. 1. Introduction Gastrinomas are neuroendocrine tumors (NET), primarily located in the duodenum or pancreas. Gastrinomas are by definition functional tumors secreting gastrin. Gastrin overproduction causes the Zollinger-Ellison syndrome, which includes ulceration of the gastrointestinal tract, mainly the jejunum, resulting in abdominal pain and diarrhea [1]. The incidence of gastrinomas is 0.5¨C2 per million per year and therefore very rare [2, 3]. Gastrinomas are classified according to a grading system, similar to other pancreatic neuroendocrine tumors (pNETs). This grading is based on histopathology and subdivided into immunostaining for tumor markers and proliferation markers (Table 1) [4]. Using the current WHO criteria, grades 1 and 2 are well-differentiated pNETs with increased expression of the tumor markers, chromogranin A, and synaptophysin. Grade 3 tumors are poorly differentiated with areas of necrosis and decreased expression of chromogranin A [3, 5]. Table 1: Tumor grade of gastrinomas based on proliferation markers [ 4]. Up to 25% of the gastrinomas are diagnosed when metastases are already present,
%U http://www.hindawi.com/journals/isrn.hepatology/2013/174608/