Fig. 6

Zollinger-Ellison syndrome (ZES) is caused by gastrin secreting tumors that stimulate the acid-secreting cells of the stomach to maximal activity, resulting in subsequent gastrointestinal mucosal ulceration. The primary tumor of ZES, gastrinomas, frequently occurs within the gastrinoma triangle and result in development of secondary carcinoids from hypergastrinemia. In this patient, clinically depicted in this image, nearly obstructive gastric carcinoids causing gastric outlet symptomatology were present. Additionally, multiple, large tumor nodules of gastrinomas were present in the duodenum with lymph nodes containing foci of gastrinoma disease