PMC5399202_01
Clinical course. a-1: Multiple hypervascular tumours were seen in both the lobes of the liver. a-2: A tumour 30 mm in diameter could be seen in the tail of the pancreas. b-1: Computed tomography revealed decreased sizes of all of the tumours from 2010 after the administration of octreotide. b-2: Marked reduction was also seen in the size of the tumour in the pancreatic tail. c-1: A slight increase in the size of the liver tumours was seen on computed tomography from 2014, when symptoms recurred. c-2: The tumour in the pancreas also increased in size, which was comparable to that of the first image obtained 4 years previously. d-1: After the administration of everolimus, the metastatic liver tumour shrank in size. d-2: The tumour in the pancreas did not shrink in size.
1349-7235-56-0517-g001.jpg
PMC5399202_01_1349-7235-56-0517-g001.jpg
g001
Computed tomography (CT) showed multiple tumours in both lobes of the liver (Fig. 1a-1, 1a-2). Thereafter, maintenance therapy with a long-acting form of octreotide (Sandostatin LAR(R), 30 mg intramuscularly once monthly) was prescribed, which sustained the improvement in symptoms and tumour size on CT (Fig. 1b-1, 1b-2). A CT examination at that time revealed the enlargement of multiple hypervascular tumours in both lobes of the liver and a tumour in the pancreatic tail (Fig. 1c-1, 1c-2). However, because the liver tumour mass had decreased in size, we opted for continuation of everolimus treatment and management of the endocrine symptoms with TAE (Fig. 1d-1, 1d-2).
Endosonographic findings of a tumour in the pancreatic tail. A hypoechoic tumour 20 mm in diameter with distinct borders was seen in the pancreatic tail on endoscopic ultrasound.
1349-7235-56-0517-g002.jpg
PMC5399202_01_1349-7235-56-0517-g002.jpg
g002
A diagnosis of pancreatic NET (P-NET; VIPoma) was made, with a World Health Organization (WHO) classification of G2 (Fig. 2, 3).
Histopathologic features of the pancreatic neuroendocrine tumour. A: 40x, Approximately 10% of the tumour cells appeared MIB-1 positive on Hematoxylin and Eosin staining, so the tumour was classified as G2. B: 40x, On VIP immunostaining, the cytoplasm was stained granularly and diffusely.
1349-7235-56-0517-g003.jpg
PMC5399202_01_1349-7235-56-0517-g003.jpg
g003
A diagnosis of pancreatic NET (P-NET; VIPoma) was made, with a World Health Organization (WHO) classification of G2 (Fig. 2, 3).
Image of TAE for liver metastasis. Hypervascular tumour staining was seen in three places in the right hepatic artery region.
1349-7235-56-0517-g004.jpg
PMC5399202_01_1349-7235-56-0517-g004.jpg
g004
Abdominal angiography in September 2014 revealed at least three deeply stained tumours in the right hepatic artery region and multiple small tumour stains around the largest tumour in S6 of the liver (Fig. 4).