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The pentagastrin test as an indicator of a cure in surgically treated patients with advanced carcinoid disease
Author(s) -
Ahlman H.,
Nilsson O.,
Dahlström A.,
Tisell L. E.
Publication year - 1988
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930380114
Subject(s) - pentagastrin , medicine , carcinoid syndrome , abdomen , enolase , provocation test , gastroenterology , urinary system , serotonin , gastrin , chromogranin a , pathology , endocrinology , surgery , immunohistochemistry , stomach , gastric acid , alternative medicine , receptor , secretion
A unique case of midgut carcinoid with advanced disease, engaging lymphnodes and liver but still accessible to curative surgery, is reported. Besides elevated urinary levels of 5‐hydroxyindoleacetic acid, the diagnosis was based on a positive provocation test with pentagastrin, i.e., basally elevated levels of serotonin in peripheral whole blood increased twofold 3 min postinjection related to the appearance of carcinoid symptoms. After removal of primary and secondary lesions in a two‐step procedure carcinoid symptoms disappeared completely. Biochemically, urinary excretion of 5‐hydroxyindoleacetic acid and serotonin levels in peripheral blood before and during provocation with pentagastrin were both normalized after surgery and have remained so during 27 months of follow‐up. Computed tomographies of the abdomen at regular intervals do not indicate recurrent disease. Histologically, the carcinoid lesions displayed a mixed growth pattern and signs of local aggressiveness. Immunocytochemically, the majority of the tumour cells (positive against neuron specific enolase) showed a positive reaction with serotonin antisera. Substance P‐like immunoreactivity was also found in a large proportion of these cells.