Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Hyperplastic polyposis and cancer of the colon with gastrinoma of the duodenum

Abstract

Background A 64-year-old woman presented to the emergency room with a 3-month history of intermittent abdominal cramps, accompanied by nausea, vomiting, anorexia, and decreased bowel movements consistent with a partial intestinal obstruction. She had a 12-year history of peptic ulcers, which had been treated with histamine-2 blockers.

Investigations Physical examination, abdominal X-ray, abdominal CT scan, colonoscopy and assessment of gastrin levels.

Diagnosis Duodenal neuroendocrine neoplasm showing gastrin expression and stage III (T3N2M0), poorly differentiated adenocarcinoma of the cecum arising from hyperplastic polyposis.

Management Right-sided hemicolectomy with ileocolonic anastomosis, duodenal resection, leucovorin and 5-fluorouracil chemotherapy, annual colonoscopic surveillance, and polypectomy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Gastrin expression by a neuroendocrine tumor of the duodenum.

References

  1. Jensen RT (2004) Gastrinomas: advances in diagnosis and management. Neuroendocrinology 80 (Suppl 1): S23–S27

    Article  Google Scholar 

  2. Gibril F et al. (2004) Multiple endocrine neoplasia type 1 and Zollinger–Ellison syndrome: a prospective study of 107 cases and comparison with 1,009 cases from the literature. Medicine (Baltimore) 83: 43–83

    Article  Google Scholar 

  3. Jass JR (2005) Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol 2: 398–405

    Article  CAS  Google Scholar 

  4. Torlakovic et al. (2003) Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27: 65–81

    Article  Google Scholar 

  5. Jass JR (2000) Familial colorectal cancer: pathology and molecular characteristics. Lancet Oncol 1: 220–226

    Article  CAS  Google Scholar 

  6. Watson SA and Smith AM (2001) Hypergastrinemia promotes adenoma progression in the APCMin−/+ mouse model of familial adenomatous polyposis. Cancer Res. 61: 625–631

    CAS  PubMed  Google Scholar 

  7. Fearon ER and Vogelstein B (1990) A genetic model for colorectal tumorigenesis. Cell 61: 759–767

    Article  CAS  Google Scholar 

  8. Baldwin GS and Shulkes A (1998) Gastrin, gastrin receptors and colorectal cancer. Gut 42: 581–584

    Article  CAS  Google Scholar 

  9. Tarasova NI et al. (1997) Endocytosis of gastrin in cancer cells expressing gastrin/CCK-B receptor. Cell Tissue Res 287: 325–333

    Article  CAS  Google Scholar 

  10. Seva C et al. (1996) Gastrin induces tyrosine phosphorylation of Shc proteins and their association with the Grb2/Sos complex. FEBS Lett 378: 74–78

    Article  CAS  Google Scholar 

  11. Todisco A et al. (1997) Molecular mechanisms for the growth factor action of gastrin. Am J Physiol 273: G891–G898

    CAS  PubMed  Google Scholar 

  12. Miyazaki Y et al. (1999) Gastrin induces heparin-binding epidermal growth factor-like growth factor in rat gastric epithelial cells transfected with gastrin receptor. Gastroenterology 116: 78–89

    Article  CAS  Google Scholar 

  13. Fukui H et al. (1998) Regenerating gene protein may mediate gastric mucosal proliferation induced by hypergastrinemia in rats. Gastroenterology 115: 1483–1493

    Article  CAS  Google Scholar 

  14. Rengifo-Cam W and Singh P (2004) Role of progastrins and gastrins and their receptors in GI and pancreatic cancers: targets for treatment. Curr Pharm Des 10: 2345–2358

    Article  CAS  Google Scholar 

  15. House MG et al. (2003) Aberrant hypermethylation of tumor suppressor genes in pancreatic endocrine neoplasms. Ann Surg 238: 423–431

    PubMed  PubMed Central  Google Scholar 

  16. Hyman NH et al. (2004) Hyperplastic polyposis and the risk of colorectal cancer. Dis Colon Rectum 47: 2101–2104

    Article  Google Scholar 

  17. Ferrandez A et al. (2004) Phenotypic characteristics and risk of cancer development in hyperplastic polyposis: case series and literature review. Am J Gastroenterol 99: 2012–2018

    Article  Google Scholar 

  18. Lage P et al. (2004) Management of Portuguese patients with hyperplastic polyposis and screening of at-risk first-degree relatives: a contribution for future guidelines based on a clinical study. Am J Gastroenterol 99: 1779–1784

    Article  CAS  Google Scholar 

  19. Popat S et al. (2005) Systematic review of microsatellite instability and colorectal cancer prognosis. J Clin Oncol 23: 609–618

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the genetic counselors L Kasprzak and L Palma for their assistance. This study was supported by the Canadian Institutes of Health Research (CIHR), grant No. MOP-67206.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeremy R Jass.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goswami, R., Minoo, P., Baker, K. et al. Hyperplastic polyposis and cancer of the colon with gastrinoma of the duodenum. Nat Rev Clin Oncol 3, 281–284 (2006). https://doi.org/10.1038/ncponc0482

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc0482

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing