Our second pancreatic Islet cell tumor is
You may know this as being ZE, Zollinger-Ellison.
Now, to make this really interesting for you
is that if you are thinking gastrin, physiologically,
where is gastrin being released?
From your G cells in the antrum of the stomach.
Would you please remind me where we are in
So, obviously, the question is, “Well, Dr.
Raj, how is it that I have a gastrin producing
tumor in the pancreas when normally you and
I should have gastrin being produced in the
Because this is a malignant cancer, okay?
So, whenever you have malignancy, please understand
that the cancer can do whatever it wants,
wherever it wants to go; here, it chooses
peculiarly to be in the pancreas.
May also occur in the duodenum, keep that
in mind, or in the peripancreatic tissue.
You call this the gastrinoma “triangle”,
okay, right around that area of the pancreas.
Results in ZE syndrome, what does that mean
It means that with all this gastrin that you
are producing, which is a hormone, we are
entering circulation, work on the parietal
cell just like you would normally, excessively
this time and that gastrinoma, excuse me,
the gastrin and the CCKMB type of receptor
complex is then going to stimulate hydrochloric
acid secretion, [sound], excessively.
Now, there is a huge wave of acid coming out
of the stomach into the duodenum, a wave of
Now, at least the stomach maybe perhaps could
handle that acid, so you may not have peptic
ulcer disease in the stomach, perhaps you
do, but if that acid is coming out of the
stomach in great abundance into the duodenum,
there is no way that the lining of the duodenum
can handle all that acid.
So, what does that acid do?
It starts eroding the lining with erosion
called pathologically ulceration, recurrent,
recurrent, recurrent, refractory.
It doesn’t want to respond to H2 blockers,
this thing is not responding to PPI perhaps.
And in addition, you have heard of gastric
peptic ulcer disease, you have heard of duodenal
peptic ulcer disease, have you really spent
too much time on jejunal peptic ulcer disease?
So, if you find the peptic ulcer disease in
the jejunum, maybe, maybe, along with this,
all this acid destroying everything, it is
kind of like a volcano that erupted, huh,
everything that is in its path will be ultimately
All this acid, think of it as being the lava,
it is destroying everything in its path so
you are going to have malabsorption and you
are going to have diarrhea, massive diarrhea,
massive over production of acid; ulcer is
in the jejunum, my goodness, high on the differential,
a gastrinoma, a second type of pancreatic
Islet cell tumor.