Peripancreatic lymph node gastrinoma

Gastrinoma is one of the most symptomatic pancreatic endocrine tumors and is associated with recurrent gastric or duodenal ulcer and an induction of chronic gastric acid hypersecretion. This tumor is commonly involved within the gastrinoma triangle. Herein we report a peripancreatic lymph node gastrinoma in a 56-year-old man who was suffered from a recurrent duodenal or jejunal ulcer perforation. Octreotide scan detected a peripancreatic or periduodenal mass and the serum gastrin level was set in upper normal range (107.73 pg/mL). Whipple's procedure was performed. The resected specimen showed multiple duodenal ulcers, hypertrophic gastric body mucosa and an enlarged peripancreatic node, measured 1.5 × 1.0 cm in cross diameter. Microscopic examination revealed a single enlarged lymph node replaced by tumor cell nests with pale eosinophilic cytoplasm and ‘salt-and-pepper’ chromatin pattern. On immunohistochemical staining, the tumor cells were diffusely positive for chromogranin, synaptophysin, gastrin and focally positive for CD56. He was finally diagnosed as a primary lymph node gastrinoma. After operation, the patient revisited our hospital due to severe esophageal stricture and he underwent endoscopic esophagoplasty.