Unexpected Regression of a Pancreatic Gastrinoma after Arterial Chemoembolization of its Hepatic Metastases: Case Report

Gastrinoma is a rare cause of peptic ulcers and should be suspected when manifestations, ulcer site, and response to treatment are not normal. Gastrinomas are mostly malignant and liver is the most common site of their metastasis. Arterial chemoembolization (obstruction by blood clotting with chemicals) and arteries that feed metastases, is used as a method to reduce the symptoms. Appropriate response is seen in more than half of the patients, although it is short term.
Case report: The patient is a 42-year old man, who was healthy until 4 years ago that experienced acute abdominal pain due to duodenal ulcer rupture and two episodes of acute upper gastrointestinal bleeding due to perforation of two separate duodenal ulcers within 2 months of each other. He also complained of mild diarrhea and loss of appetite at that time. Laboratory examinations showed increased serum level of gastrin. Abdominal CT scan showed a small pancreatic head mass and three hepatic mass with increased contrast medium absorption. In CT-guided biopsy report, pancreatic head mass and uniform and apparently benign cells similar to islet cell tumor, were seen. Chemoembolization of liver metastasis arteries was performed, which after 6 months, CT scan showed almost complete regression of metastases and also primary pancreatic lesion.