PMC6091168_01
Imaging findings demonstrating pituitary macroadenoma and pancreatic adenoma. a MRI demonstrates enlarged pituitary extending into suprasellar cistern (white arrow) and elevating optic chiasm. b MRI of abdomen demonstrated normal pancreatic signal intensity without identification of any focal lesion or masses. c Endoscopic ultrasound revealed circumscribed hypoechoic mass (white arrow) in body/tail of pancreas. d CT image demonstrating hyperenhancing mass in distal pancreatic body (white arrow)
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Fig1
Brain and pituitary MRI showed a 2.0 x 1.5 x 1.9 cm enhancing mass expanding the sella turcica (Fig. 1a). Magnetic resonance imaging (MRI) of abdomen and pelvis with contrast was negative for any lesion or lymph node enlargement (Fig. 1b). Endoscopic ultrasound (EUS) identified a circumscribed 12 x 11 mm hypoechoic mass in the pancreatic body/tail (Fig. 1c). Computed tomography (CT) of the abdomen was pursued for additional surgical planning, confirming presence of a 1.2 x 0.9 cm hyperenhancing mass in the distal pancreatic body with no evidence of metastatic disease (Fig. 1d).
Immunohistochemical staining of pancreatic insulinoma. a Hematoxylin & eosin stain showing the tumor cells, b Congo red stain highlighting amyloid deposition, c Synaptophysin stain demonstrating neuroendocrine differentiation, and d Ki67 stain showing a proliferation index of 1-2%. Images acquired at 200X magnification
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Fig2
Immunostaining of a fine needle aspirate of the suspicious lesion was positive for chromogranin, synaptophysin, and insulinoma-associated-1 gene (INSM1) with 2-3% Ki-67 proliferation, confirming low-grade insulinoma (Fig. 2).