A Case Report of Multiple Endocrine Neoplasia Type 1 with Duodenal Microgastrinoma and Pancreatic Insulinoma

Takashi Doi, Iwao Sasaki, Hiroo Naito, Yuji Funayama, Yasuhiko Kamiyama, Michinaga Takahashi, Kouhei Fukushima, Chikashi Shibata, Hideo Segami, Noriya Otani, Akihiro Iwatsuki, Seiki Matsuno, Michiaki Unno, Seiichi Ohira*

First Department of Surgery, Tohoku University School of Medicine
*Department of Gastroenterology, Sendai City Hospital

A 42-year-old man complained of epigastric discomfort after gastrectomy for a duodenal ulcer. Endoscopic examination revealed an anastomotic ulcer. Blood chemistry tests revealed hypergastrinemia, hyperPTHemia, hypercalcemia, and hyperprolactinemia. The fasting plasma insulin level was within normal limits, but the postprandial plasma insulin level was very high. We detected tumors in the pituitary gland, parathyroid gland, and pancreas, so we made a diagnosis of multiple endocrine neoplasia type 1. Computed tomography and ultrasonography of the abdomen revealed that the pancreatic tumor was solitary and located in the pancreatic head. Pancreaticoduodenectomy was performed, and we detected a solitary tumor in the pancreatic head. Histological examination of the resected specimen revealed tumors not only in the pancreatic head but also in the duodenal wall. The duodenal tumors were very small and multiple, and could not be detected during the operation. Immunohistochemical study and mRNA expression of these tumors suggested that insulin was produced in the pancreatic tumor and gastrin was produced in the duodenal microtumors.

Key words
multiple endocrine neoplasia type I, microgastrinoma, selective arterial secretin injection test

Reprint requests
Takashi Doi First Department of Surgery, Tohoku University School of Medicine
1-1 Seiryo-cho, Aoba-ku, Sendai, 980 JAPAN

Accepted
January 11, 1995

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