gastrins and Common-Bile-Duct-Neoplasms

Palliative operation plays an important part in the treatment of periampullary carcinoma. However, gastric bypass such as the widely practiced side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunostomy in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical operation. Early results were satisfactory in all patients. They began to eat liquid meals within a week, and were discharged uneventfully within the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin levels following a test meal was significantly lower after the operation, but plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery. This duodenojejunal bypass is recommended as a means of improving the quality of the remaining life of the patients.

Topics: Aged; Ampulla of Vater; Biliopancreatic Diversion; Choledochostomy; Common Bile Duct Neoplasms; Duodenostomy; Female; Gastric Emptying; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Transit; Humans; Jejunostomy; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; Postoperative Care; Sincalide; Survival Rate

Carcinoid tumors of the biliary tract are rare. We report a 47 year-old man who was unexpectedly found to have a nonobstructing carcinoid tumor of the common bile duct during orthotopic liver transplantation for decompensated cirrhosis. No metastases were noted. Five months after resection of the common bile duct and liver transplantation, the patient had no evidence of residual tumor. The carcinoid was a sclerotic tumor of insular type and was immunoreactive for gastrin and serotonin, but nonfunctional. We review the literature on carcinoids of the extrahepatic bile duct.

Topics: Adult; Carcinoid Tumor; Common Bile Duct; Common Bile Duct Neoplasms; Gastrins; Humans; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Serotonin

Primary endocrine neoplasms of intra- and extrahepatic biliary ducts are very rare. We describe the first case of a primary endocrine tumor of the common bile duct producing gastrin. A 53-year-old woman had a 3-year history of recurrent duodenal and gastric ulcers as well as obstructive jaundice. A small neoplasm was found in the lower third of the common bile duct, which showed diffuse gastrin production and focal synthesis of serotonin and pancreatic polypeptide by immunohistochemistry and electron microscopy. Although serum gastrin was within normal levels (90 ng/ml), symptoms of peptic acid disease could have been related to hypergastrinemia, since gastric and duodenal ulcers healed after surgical removal of the tumor. She has remained asymptomatic for 8 months.

Topics: Cholestasis; Common Bile Duct Neoplasms; Duodenal Ulcer; Female; Gastrinoma; Gastrins; Humans; Immunohistochemistry; Middle Aged; Stomach Ulcer

Processing-independent radioimmunoanalysis for progastrin showed that extracts of normal pancreatic tissue from normal subjects (n = 5) and from patients with adenocarcinoma of the papilla of Vater (n = 4) contain progastrin and its products. The concentrations varied from 0.1 to 5.8 pmol/g tissue, of which carboxyamidated bioactive gastrins constituted 0.03-1.9 pmol/g. In histologically normal and nonneoplastic pancreatic tissue from patients with duodenal (n = 3) and pancreatic (n = 2) gastrinomas the expression of gastrin was significantly higher-14.5 pmol/g (median), of which 28% was bioactive amidated gastrins. Gastrin-17 was the main bioactive product, but its immediate precursor, glycine-extended gastrin-17, constituted the predominant part of the preprogastrin product in pancreatic tissue. Proper gastrinoma tissue contained several precursor forms, including intact unprocessed progastrin. Progastrins were also found in high concentrations in plasma from the gastrinoma patients. The results raise the possibility that increased expression of progastrin and its products in non-neoplastic pancreatic tissue is a primary defect predisposing to neoplasia.

Topics: Adenocarcinoma; Ampulla of Vater; Common Bile Duct Neoplasms; Gastrinoma; Gastrins; Gene Expression; Humans; Pancreas; Pancreatic Neoplasms; Protein Precursors; Protein Processing, Post-Translational; Zollinger-Ellison Syndrome

Histochemical and immunohistochemical studies on 47 consecutive specimens excised for choledochal cyst were performed to clarify possible metaplastic changes of the biliary duct in relation to carcinogenesis. An anomalous arrangement of the pancreaticobiliary ductal system was observed in all 39 cases examined. Among the 47 patients, 5 (10.6 per cent) had biliary carcinoma. 27.3 per cent mucous gland, 13.0 per cent goblet cell and 9.5 per cent argyrophil cell in 23 children. On the other hand, 81.8 per cent exhibited mucous gland, 41.7 per cent goblet cell and 27.3 per cent argyrophil cell in 24 adults. These metaplastic changes seemed to be an intestinal metaplasia and increased with age. Immunoreactive-gastrin or -somatostatin were evident immunohistochemically in 4 adults. These findings confirmed that intestinal metaplasia may develop in the biliary duct in cases of choledochal cyst. Although direct evidence between intestinal metaplasia and the development of biliary carcinoma was not found, reflux and stasis of pancreatic enzymes in the biliary duct may relate to the development of intestinal metaplasia and be an important factor related to the carcinogenesis of choledochal cyst.

Topics: Adenoma, Bile Duct; Adolescent; Adult; Common Bile Duct; Common Bile Duct Diseases; Common Bile Duct Neoplasms; Cysts; Exocrine Glands; Female; Gastrins; Humans; Immunoenzyme Techniques; Male; Middle Aged; Mucus; Somatostatin; Staining and Labeling

Histological, histochemical and clinical features of an endocrine duodenal tumour situated in the papillary region were studied. The tumour had a remarkable mixed histological growth pattern, consisting of epithelial glandular structures which showed a gradual transition into a spindle-cell tumour, resembling a neurogenic tumour. The neoplasm was considered malignant since it had infiltrated into the muscular layer of the duodenal wall. The tumour was non-argentaffin and non-argyrophil. No serotonin could be demonstrated histochemically. Immunoreactive pancreatic polypeptide (HPP) was detected by indirect immunofluorescence in the majority of tumour cells of the epithelial glandular structures, whereas areas with a spindle-cell pattern were almost unreactive to the HPP-antiserum. No reaction was found with antibodies against gastrin, insulin, glucagon, vasoactive intestinal polypeptide or somatostatin. The patient had no endocrine symptoms that could be ascribed to the production of HPP by the neoplasm. Twenty-four months postoperatively, the patient's serum HPP concentration had begun to rise, suggesting recurrence of the tumour.

Topics: Ampulla of Vater; Common Bile Duct Neoplasms; Gastrins; Glucagon; Humans; Insulin; Male; Middle Aged; Pancreatic Polypeptide; Serotonin; Somatostatin; Vasoactive Intestinal Peptide