PMC3616096_01
The patient showed multiple lipomas. (A) Abdominal multiple tumors. (B) Histology of the abdominal tumor biopsies confirmed that the tumors were multiple lipomas (H&E staining).
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Physical examination at this time showed acromegaly, anemia and abdominal lipoma, confirmed by hematoxylin-eosin staining (Figure 1).
Multiple duodenal ulcers were observed using gastroscopy. (A) Multiple duodenal ulcers with massive bleeding. (B) Multiple duodenal ulcers were ameliorated 2 months after surgical removal of pancreatic endocrine neoplasia. (C,D) Duodenal ulcers healed well 1 year after surgical removal of pancreatic endocrine neoplasia.
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Endoscopic examination of the upper gastrointestinal tract indicated erosive gastritis and multiple duodenal ulcers with bleeding (Figure 2). However, a second endoscopic examination revealed that the ulcer remained intractable (Figure 2).
Computed tomography (CT) scan and endoscopic ultrasonography (EUS) examination indicated a tumor (yellow arrow) in the corpus pancreas. (A) Plain CT scan image. (B) CT image in the arterial phase of contrast enhancement. (C) CT image in the parenchymal phase of contrast enhancement. (D) EUS image.
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Abdominal computed tomography (CT) showed a mass 5 cm in diameter in the corpus pancreas, which was confirmed by endoscopic ultrasonography (Figure 3). Endoscopic examination of the upper gastrointestinal tract demonstrated that the erosive gastritis and multiple duodenal ulcers had healed after 1 year of PPI treatment (Figure 3).
Histopathology and immunohistochemical staining demonstrated that the pancreatic tumor was an endocrine neoplasia. In the upper images, yellow arrows point to the tumor tissue, and green arrows point to non-tumor tissue. In the lower images, immunohistochemical staining showed that the pancreatic tumor was an endocrine neoplasia, Syn (+), CgA (+), NSE (+), CD56 (+), Somatostatin (+), PR (+), Insulin (+), Glucagon (-), and CK (+); original magnification x100.
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H&E staining revealed an endocrine neoplasia in the tumor, and immunohistochemistry demonstrated synaptophysin (Syn +), chromogranin (CgA +), neuron-specific enolase (NSE +), CD56 (+), somatostatin (+), progesterone (PR +), insulin (+), glucagon (-) and cytokeratin (CK +) (Figure 4).