Recent standardization of treatment strategy for pancreatic neuroendocrine tumors

Figure 1 Schema of the selective arterial secretagogue injection test. Results of the selective arterial secretagogue injection (SASI) test in a patient with Zollinger-Ellison syndrome. In this patient, serum immunoreactive gastrin (IRG) at 40 s after the injection of 30 units of secretin rose only after injection into the gastroduodenal artery. Thus, it was diagnosed that the gastrinoma(s) was located in the upper part of the pancreas and/or the duodenum. Gastr.duod.a: Gastroduodenal artery; Spl.a.: Splenic artery; Superior mesenteric a.: Superior mesenteric artery.

Figure 2 Numerous mucosal gastrinomas in the duodenum. Mucosal tumors with depression (arrows).

Figure 3 A cluster of G cells in hyperplasia of duodenal Brunner’s glands in a patient with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome.