QUIZ: No. 2, 18/01/2026

 CT

Diagnosis –Gastrinoma (Zollinger–Ellison syndrome)

Findings - Well-defined arterial phase hyperenhancing lesion in the uncinate process of pancreas, showing washout on venous phase. Associated diffuse gastric fold thickening suggestive of acid hypersecretion. No features of acute pancreatitis.

Discussion

Gastrinoma is a functioning pancreatic or duodenal neuroendocrine tumor causing excessive gastrin secretion, typically with serum gastrin levels >1000 pg/mL.

 Approximately 90% of gastrinomas occur within the gastrinoma (Passaro’s) triangle involving the duodenum and pancreatic head.

On imaging, gastrinomas are small hypervascular lesions with intense arterial phase enhancement.Gastrinomas overexpress somatostatin receptors—In-111 octreotide scintigraphy (and Ga-68 DOTATATE PET/CT) shows high sensitivity for localization and staging.
Treatment - High-dose proton pump inhibitors for acid control, surgical resection for localized disease, and somatostatin analogs ± targeted therapy for metastatic or unresectable gastrinoma.

Teaching Pearl:
Recurrent or refractory peptic ulcers + diarrhea + arterial phase hyperenhancing pancreatic/duodenal lesion = think gastrinoma.

P.S – Diagnosis is supported by markedly elevated fasting serum gastrin.