PMC6319689_01
Hypervascular pancreatic body mass with intraluminal enhancement within portal vein consistent with tumor thrombus (arrow).
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The mass appeared to abut the splenic vein and portosplenic confluence with evidence of thrombus within the lumen of the portal vein (Fig. 1).
CgA and PP levels before, during, and after treatment course. CgA, chromogranin A; PP, pancreatic polypeptide.
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Before the aforementioned initial resection, serum pancreatic polypeptide and chromogranin A levels had been elevated to 547 pg/mL and 15.8 ng/mL, respectively; with the onset of these new symptoms, the pancreatic polypeptide level was found to be only 226 pg/mL, but the chromogranin A level was elevated to 33 ng/mL (Fig. 2).
(A) Initial abdominal CT scan demonstrating pancreatic body lesion (yellow circle). (B) Abdominal CT scan 1 year after distal pancreatectomy and splenectomy with gastric mass visible (yellow circle). (C) Octreotide scan with enhancement of the posterior gastric wall (yellow circle). (D) Sagittal cut of abdominal CT scan showing gastric mass extending posteriorly (yellow arrows) toward the left adrenal gland. (E) Postoperative gastrographin swallow showing anatomical reconstruction through esophagojejunostomy.
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CT scan findings confirmed the presence of this gastric soft tissue mass and also revealed a posterior nodular extension toward the upper pole of the left kidney (Fig. 3).
(A) Original pancreatic mass with synaptophysin staining, 20x magnification. (B) Original pancreatic mass with HE staining, 40x magnification. (C) Recurrent gastric mass with HE staining, 40x magnification. HE, hematoxylin and eosin.
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The lesion was again confirmed to be morphologically similar to the patient's previous PNET (Fig. 4).