PMC5687133_01
(NMR) pituitary macroadenoma and left superior parietal extra-axial lesion compatible with meningioma.
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fig1
A nuclear magnetic resonance (NMR) revealed a pituitary macroadenoma of 20 x 13 x 15 mm which spread to the right cavernous sinus, with displacement of the optic chiasm, and a left superior extra-axial parietal lesion of 20 x 20 x 12 mm which suggested a meningioma (Figure 1).
(CT) tail of pancreas with hypervascular heterogeneous and well-defined mass with lobulated edges measuring 6.8 x 7.7 x 6.4 cm.
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fig2
Given these findings and the clinical suspicion of MEN1, the study was completed with a CT scan of the neck, chest, abdomen, and pelvis, which showed a hypervascular heterogeneous mass with lobulated and well-defined edges of 6.8 x 7.7 x 6.4 cm in the tail of pancreas, plus another mass of similar characteristics of 6 x 4.2 cm in the uncinate process and at least three more pancreatic focal lesions of less than 1 cm on the head and neck of pancreas (Figure 2).
OctreoScan showing a pathological deposit at the upper left parietal level caused by meningioma and in the tail of pancreas.
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fig3
A somatostatin receptor scintigraphy (OctreoScan) was performed showing a pathological deposit in the tail of pancreas which suggested a tumor with expression of somatostatin receptors and also at the upper left parietal level, which was caused by a meningioma (Figure 3).
Immunohistochemistry with positive cells for glucagon.
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fig4
A and synaptophysin, with proliferation mediated by Ki67 <1%, except for the node found in the neck of pancreas, in which it reached 2-3%. Also, 2 out of the 7 tumors were intensely positive for glucagon (100%) (Figure 4), and an additional node in the body of pancreas was positive for calcitonin (70%), with positive isolated cells for glucagon and somatostatin (<2%).