Presentation
Incidental found while investigation for an episodic abdominal pain, no other symptoms.
Patient Data
Ultrasound shows a circumscribed hypoechoic mass in the pancreatic body measuring approximately 1.7 cm in its larger diameter.
There is a hypervascular lesion within the proximal pancreatic body. No peripancreatic or retroperitoneal lymphadenopathy.
Hepatic cysts also noted. No liver metastases.
Multiple surgical clips adjacent to the second part of the duodenum.
Procedure: 185 MBq of Ga-68 octreotate was administered intravenously and images obtained from the vertex of the skull to the upper thighs with a dedicated PET/CT. Ga-68 octreotate uptake time = 76 min.
Findings: There cis intense GaTate uptake in the pancreatic body, corresponding to the hypervascular mass on CT.
No GaTate avid retroperitoneal lymphadenopathy or further abnormal areas of GaTate uptake, including in the liver, to suggest octreotate avid metastases.
Physiological octreotate activity is demonstrated in the salivary glands, pituitary gland, thyroid, liver, spleen, bowel, kidneys and urinary bladder. Stable non-avid cysts in the left hepatic lobe.
Conclusion: Well-differentiated neuroendocrine tumor involving the pancreatic body.
Macroscopy: A tan biopsy 3mm, with accompanying blood clot up to 14mm in aggregate.
Microscopy: The sample mostly comprises blood, pancreatic acini and ductal epithelium. There are a few loosely cohesive aggregates (up to 1mm) of cells with small and round nuclei, fine chromatin, inconspicuous nucleoli and moderate amounts of granular and eosinophilic cytoplasm. Mitoses are not seen. With immunohistochemistry, these cells show positive staining for cytokeratin AE 1/3, synaptophysin and chromogranin. The Ki-67 index is less than 2%.
Conclusion: Pancreatic body biopsy: limited sample compatible with a low-grade neuroendocrine tumor.
Case Discussion
This case illustrates a pancreatic neuroendocrine tumor that has been followed by imaging and has remained stable over an almost two years time.
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