Browse > Article
http://dx.doi.org/10.3904/kjm.2014.87.3.363

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

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)
Publication Information
The Korean Journal of Medicine / v.87, no.3, 2014 , pp. 363-368 More about this Journal
Abstract
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.
Keywords
VIPoma; Liver metastases; Hepatic artery embolization; Diarrhea;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Remme CA, de Groot GH, Schrijver G. Diagnosis and treatment of VIPoma in a female patient. Eur J Gastroenterol Hepatol 2006;18:93-99.   DOI
2 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.
3 Grier JF. WDHA (watery diarrhea, hypokalemia, achlorhydria) syndrome: clinical features, diagnosis, and treatment. South Med J 1995;88:22-24.   DOI   ScienceOn
4 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.   DOI   ScienceOn
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.   DOI   ScienceOn
6 Ajani JA, Carrasco CH, Wallace S. Neuroendocrine tumors metastatic to the liver: vascular occlusion therapy. Ann N Y Acad Sci 1994;733:479-487.   DOI
7 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.   DOI   ScienceOn
8 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.   DOI   ScienceOn
9 Ito S, Kasturagi M, Otsuji H, et al. Transcatheter embolization of metastatic liver VIPoma: report of a case. Rinsho Hoshasen 1987;32:1169-1172.
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.   DOI   ScienceOn
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.   DOI   ScienceOn
12 Fjallskog ML, Granberg DP, Welin SL, et al. Treatment with cisplatin and etoposide in patients with neuroendocrine tumors. Cancer 2001;92:1101-1107.   DOI   ScienceOn
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.   DOI
14 Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 2008;9:61-72.   DOI   ScienceOn
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.   DOI   ScienceOn
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.   DOI   ScienceOn