0
Invited Commentary |

The Origin of Sporadic Gastrinomas Within the Gastrinoma Triangle—Invited Commentary

Courtney M. Townsend, MD
Arch Surg. 1998;133(1):17. doi:10.1001/archsurg.133.1.17.
Text Size: A A A
Published online

Extract

The original report by Stabile et al1 that the gastrinoma triangle harbored most sporadic gastrinomas was a seminal clinical observation. Its importance to the study of gastrointestinal endocrine tumors is no less than that of William Beaumont to gastric physiology. From the observation that most sporadic (nonhereditary, ie, multiple endocrine neoplasia type I) gastrinomas occurred in the gastrinoma triangle, these investigators have continued to examine this phenomenon. They have removed the mystery from the "ectopic" gastrinomas. The mystery sprung from the false concept that all gastrinomas should arise in the pancreas; the original patients had pancreatic neoplasms. No gastrin-containing cells can be identified in the adult human pancreas. The authors' work has been hampered by the relative rarity of these tumors and the inability to conduct a prospective randomized trial. However, their prescient observation and persistent examination have led them to their current description.2 Passaro et al2 provide a strong argument for 2 types of sporadic gastrinomas: those that occur (most) in the gastrinoma triangle that apparently arise from a stem cell from the ventral pancreatic bud, the cells of which produce pancreatic polypeptide—a marker of ventral bud origin—and those that arise outside. Tumors that arise in the gastrinoma triangle or, possibly, from the ventral bud have different, less aggressive, biologic behavior from those sporadic gastrinomas that arise outside the triangle. The authors propose that the role of these cells during early fetal development (none can be found in the adult) may possibly be related to the known trophic effects of gastrin, which we and others have described, and that they are vital for the development of the gut; this may explain the less aggressive tumors.

Topics

gastrinoma

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();