Gastrinomas mainly occur in the duodenum and pancreas. Primary hepatic
gastrinoma is rare and difficult to diagnose because the liver is a frequent site of metastatic
gastrinomas. Clinical factors were assessed in a 28-year-old man with
diarrhea and
heartburn who was hospitalized for recurrent
duodenal ulcers. Abdominal ultrasound, endoscopic ultrasound and computed tomography (CT) could not detect a
tumor in the duodenum or pancreas. His
gastrin level was 846 pg/mL and magnetic resonance imaging showed a mass 12 mm in diameter in the right robe of the liver. A selective intra-arterial
calcium injection (SACI) test and 68-gallium
edotreotide positron emission tomography CT (Ga-
DOTATOC PET-CT) were therefore performed.
Calcium gluconate injection into the proper hepatic artery resulted in a marked increase in serum
gastrin concentration in the right hepatic vein, with Ga-
DOTATOC PET-CT showing uptake only by the liver mass. Following a diagnosis of primary hepatic
gastrinoma, the
tumor was resected. A histopathological examination indicated
gastrinoma. Six months postoperatively, he has no symptoms, is not taking
proton-pump inhibitors and his
gastrin level remains within the normal range. The SACI test and the
clinical course of this patient strongly suggest that the
tumor was a primary hepatic
gastrinoma. The SACI test is helpful in the diagnosis of primary hepatic
gastrinoma.