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A Rare Cause of Abdominal Pain and Mass in an 18-Year-Old Patient: A Diagnostic Dilemma

机译:罕见的18岁患者腹部疼痛和肿块的原因:诊断上的困境

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摘要

We present a case of an 18-year-old male who presented with complains of abdominal pain, nausea and vomiting for 2 years. An esophagogastroduodenoscopy (EGD) revealed a 3 mm nodule on the lesser curvature of the stomach and prominent gastric folds. Biopsy of the nodule revealed a well-differentiated neuroendocrine tumor (NET) in lamina prop with focal extension into muscularis mucosa consistent with a gastric carcinoid. Tumor cells stained with neuron-specific enolase (NSE), chromogranin and synaptophysin only. The prominent gastric fold biopsy revealed gastric fundic mucosa with mucosal edema and focal mild chronic inflammation. Serum gastrin level was found to be 2,083 pg/mL. Abdomen CT and endoscopic ultrasound (EUS) revealed a mass near the pancreatic neck. These findings were consistent with a functional gastrin producing well-differentiated grade 1 neuroendocrine neoplasm (gastrinoma). The patient underwent exploratory laparotomy with resection of the mass and resulting in normalization of gastrin levels.
机译:我们介绍了一例18岁的男性,该患者主诉腹部疼痛,恶心和呕吐2年。食管胃十二指肠镜检查(EGD)显示在胃小弯和明显的胃褶上有一个3 mm的结节。结节活检显示,在椎板固有层中分化良好的神经内分泌肿瘤(NET),病灶扩展至与胃类癌一致的肌层粘膜。肿瘤细胞仅用神经元特异性烯醇化酶(NSE),嗜铬粒蛋白和突触素染色。突出的胃褶活检显示胃底粘膜具有粘膜水肿和局灶性轻度慢性炎症。发现血清胃泌素水平为2,083 pg / mL。腹部CT和内镜超声检查(EUS)显示胰腺颈部附近有肿块。这些发现与功能性胃泌素产生高度分化的1级神经内分泌肿瘤(胃泌素瘤)一致。该患者接受了探查性剖腹术并切除了肿块,并导致胃泌素水平正常化。

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