The Korean Journal of Medicine

  • 제87권3호
  • /
  • Pages.363-368
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

간 전이를 동반한 VIPoma에서 간동맥 색전술을 이용한 현저한 증상 호전

Significant Symptom Relief with Hepatic Artery Embolization in a VIPoma with Liver Metastases

  • 최윤숙 (울산대학교 의과대학 서울아산병원 내과) ;
  • 고기영 (울산대학교 의과대학 서울아산병원 영상의학과) ;
  • 류민희 (울산대학교 의과대학 서울아산병원 내과) ;
  • 강신광 (울산대학교 의과대학 서울아산병원 병리과) ;
  • 김정은 (울산대학교 의과대학 서울아산병원 내과) ;
  • 송준선 (울산대학교 의과대학 서울아산병원 병리과) ;
  • 강윤구 (울산대학교 의과대학 서울아산병원 내과)
  • Choi, Yun-Suk (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Gi-Young (Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ryu, Min-Hee (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Khang, Shin Kwang (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jeong-Eun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Joon Seon (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Yoon-Koo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2008.08.03
  • 심사 : 2008.10.06
  • 발행 : 2014.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Vasoactive intestinal polypeptide-secreting tumors (VIPomas) cause VIPoma syndrome, which is characterized by watery diarrhea, hypokalemia, and achlorhydria. The treatment options for metastatic VIPomas include somatostatin analogs, cytoreductive surgery, and chemotherapy. We report the case of a 54-year-old male who presented with a peripancreatic mass with multiple hepatic metastases on computed tomography. After resection, the peripancreatic mass was demonstrated pathologically to be a neuroendocrine tumor. Although the patient received systemic chemotherapy and somatostatin analogs for the hepatic metastatic masses, the tumor increased in size. The patient then experienced severe diarrhea, despite treatment with the somatostatin analogs. Elevated serum VIP levels (3,260 pg/mL) and typical symptoms confirmed the diagnosis of VIPoma. We performed hepatic artery embolization (HAE) to reduce the tumor volume and control his symptoms, which led to a very rapid symptomatic response. The patient has remained symptom-free for 18 months with repeated HAE.

키워드

참고문헌

  1. Modlin IM, Lewis JJ, Ahlman H, Bilchik AJ, Kumar RR. Management of unresectable malignant endocrine tumors of the pancreas. Surg Gynecol Obstet 1993;176:507-518.
  2. Grier JF. WDHA (watery diarrhea, hypokalemia, achlorhydria) syndrome: clinical features, diagnosis, and treatment. South Med J 1995;88:22-24. https://doi.org/10.1097/00007611-199501000-00002
  3. Smith SL, Branton SA, Avino AJ, et al. Vasoactive intestinal polypeptide secreting islet cell tumors: a 15-year experience and review of the literature. Surgery 1998;124:1050-1055. https://doi.org/10.1067/msy.1998.92005
  4. Remme CA, de Groot GH, Schrijver G. Diagnosis and treatment of VIPoma in a female patient. Eur J Gastroenterol Hepatol 2006;18:93-99. https://doi.org/10.1097/00042737-200601000-00017
  5. Case CC, Wirfel K, Vassilopoulou-Sellin R. Vasoactive intestinal polypeptide-secreting tumor (VIPoma) with liver metastases: dramatic and durable symptomatic benefit from hepatic artery embolization, a case report. Med Oncol 2002;19:181-187. https://doi.org/10.1385/MO:19:3:181
  6. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors: European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216. https://doi.org/10.1093/jnci/92.3.205
  7. Marlink RG, Lokich JJ, Robins JR, Clouse ME. Hepatic arterial embolization for metastatic hormone-secreting tumors: technique, effectiveness, and complications. Cancer 1990;65:2227-2232. https://doi.org/10.1002/1097-0142(19900515)65:10<2227::AID-CNCR2820651011>3.0.CO;2-C
  8. Ito S, Kasturagi M, Otsuji H, et al. Transcatheter embolization of metastatic liver VIPoma: report of a case. Rinsho Hoshasen 1987;32:1169-1172.
  9. Ajani JA, Carrasco CH, Wallace S. Neuroendocrine tumors metastatic to the liver: vascular occlusion therapy. Ann N Y Acad Sci 1994;733:479-487. https://doi.org/10.1111/j.1749-6632.1994.tb17298.x
  10. Nguyen HN, Backes B, Lammert F, et al. Long-term survival after diagnosis of hepatic metastatic VIPoma: report of two cases with disparate courses and review of therapeutic options. Dig Dis Sci 1999;44:1148-1155. https://doi.org/10.1023/A:1026672022917
  11. Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D. Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 1992;326:519-523. https://doi.org/10.1056/NEJM199202203260804
  12. Fjallskog ML, Granberg DP, Welin SL, et al. Treatment with cisplatin and etoposide in patients with neuroendocrine tumors. Cancer 2001;92:1101-1107. https://doi.org/10.1002/1097-0142(20010901)92:5<1101::AID-CNCR1426>3.0.CO;2-V
  13. Wymenga AN, Eriksson B, Salmela PI, et al. Efficacy and safety of prolonged-release lanreotide in patients with gastrointestinal neuroendocrine tumors and hormone-related symptoms. J Clin Oncol 1999;17:1111. https://doi.org/10.1200/JCO.1999.17.4.1111
  14. Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 2008;9:61-72. https://doi.org/10.1016/S1470-2045(07)70410-2
  15. Khanna G, O'Dorisio SM, Menda Y, Kirby P, Kao S, Sato Y. Gastroenteropancreatic neuroendocrine tumors in children and young adults. Pediatr Radiol 2008;38:251-259.
  16. Thomason JW, Martin RS, Fincher ME. Somatostatin receptor scintigraphy: the definitive technique for characterizing vasoactive intestinal peptide-secreting tumors. Clin Nucl Med 2000;25:661-664. https://doi.org/10.1097/00003072-200009000-00001
  17. Peng SY, Li JT, Liu YB, et al. Diagnosis and treatment of VIPoma in China: (case report and 31 cases review) diagnosis and treatment of VIPoma. Pancreas 2004;28:93-97. https://doi.org/10.1097/00006676-200401000-00015