PMC6393863_01
Anatomical Relationship Between Areas and Arteries of the Pancreas Stimulated With Calcium. Relationship of the main arteries of the pancreas and the areas that irrigate: gastroduodenal (GDA), superior mesenteric (SMA), and splenic artery. The splenic artery was divided into proximal (PES) and distal (DES) to differentiate the tail of the body. The proper hepatic artery was included to rule out tumor activity in the liver (PHE). The numbers indicate the seconds at which the sample was taken after the calcium injection. This suggests the most likely localization of the lesions.
CRIE2019-7640384.001.jpg
PMC6393863_01_CRIE2019-7640384.001.jpg
fig1
High insulin levels were obtained after a selective injection of 0.025mEq/Kg calcium gluconate in the proximal splenic and gastroduodenal arteries (Table 2) (Figure 1).
Hematoxylin and eosin stain of cell-block preparations from biopsy specimen. (a) Several clusters of beta pancreatic cells are shown (arrows) (10x). (b) The typical cluster distribution near blood vessels is depicted (10x). (c) Pancreatic islets vary in size; very large islets are shown (arrow) (10x). (d) Hematoxylin and eosin stain shows cells with atypical morphology characterized by prominent nuclei and abundant granulated eosinophilic cytoplasm (40x).
CRIE2019-7640384.002.jpg
PMC6393863_01_CRIE2019-7640384.002.jpg
fig2
The macroscopic pathology report did not show any tumor compatible with insulinoma; however, on microscopic examination pancreatic islets with elongated cells and clear cytoplasm compatible with nesidioblastosis were seen (Figure 2).