PMC4528785_01
(Date: November 9, 2004) Computed tomography scan of abdomen/pelvis showed an incidental 2.5 x 2.6 cm pancreatic nonsecreting neuroendocrine tumor (arrow)
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During surveillance for her breast cancer in 2004, she was found to have an incidental 2.5 x 2.6 cm pancreatic nonsecreting endocrine tumor (Figure 1).
(A) Pancreatic tumor histology. Representative hematoxylin and eosin-stained section of resected pancreatic mass showed a well-differentiated endocrine tumor (original magnification, 20x). (B) Immunohistochemical staining for insulin was negative (original magnification, 20x). (C) Electron micrograph of pancreatic tumor. The cytoplasm contained round neuroendocrine granules with dense cores; none of the granules had the typical crystalloid structure of insulin granules (original magnification, 6000x); inset: example of crystalloid insulin granules from a normal islet (original magnification, 20 000x). (Images courtesy Elizabeth Sengupta, MD, and Jerome Taxy, MD, The University of Chicago Medical Center.) (D) Biopsy of liver lesion showed a well-differentiated endocrine neoplasm (hematoxylin and eosin stain; original magnification, 10x)
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The pathologic specimen showed a 2.1-cm neuroendocrine tumor in the body of the pancreas (Figure 2A). Immunohistologic stains of the tumor for insulin, glucagon, and somatostatin were negative (Figure 2B). Electron microscopy demonstrated cells with nonspecific granules with no evidence of insulin-type granules (Figure 2C). Biopsy of the liver lesion showed a metastatic well-differentiated neuroendocrine neoplasm (Figure 2D).
(A) Contrast-enhanced CT of the abdomen/pelvis (date: April 13, 2011) showed a dominant left lobe mass (arrow). Smaller liver lesions were also present (not shown). (B) Octreotide scan (date: April 14, 2011) showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis, and numerous additional smaller foci of increased uptake are noted in the liver consistent with metastatic disease (small arrows)
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She underwent a CT scan of her abdomen and pelvis on April 13, 2011, which showed multiple hepatic metastases, the largest of which increased in size since the previous exam (see Figure 3A). She underwent an octreotide scan that showed a focus of intense uptake in the right lobe of the liver consistent with neuroendocrine metastasis and numerous additional smaller foci of increased uptake in the liver consistent with metastatic disease (see Figure 3B).
(A) (Date: April 25, 2011) Angiogram of the left hepatic artery showed the tumoral blush (black arrow) corresponding to the
large mass on CT. Note other smaller tumoral blushes (white arrows). (B) (Date: August 31, 2011) CT of abdomen and pelvis showed residual enhancement in the large hepatic metastases near the dome of the liver. In addition, there are numerous other focal metastatic lesions visualized in both lobes of the liver. (C) (Date: September 9, 2011) CT image performed during thermoablation showed the antenna in the location of the mass. Ablation was performed because there was inadequate clinical response to chemoembolization alone. (D) (Date: January 5, 2012) Follow-up CT of abdomen/pelvis showed good control of the dominant lesion (arrow) without enhancement (arrow). (E) Same CT as in "D" at different level of the liver showed other metastatic hepatic lesions (arrows)
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She underwent transcatheter arterial chemoembolization (TACE) of left hepatic lobe for symptom control (Figure 4A). CT scan of her abdomen and pelvis showed residual enhancement in the large hepatic metastases near the dome of the liver with numerous other focal metastatic lesions visualized in both lobes of the liver (Figure 4B). She underwent repeat TACE and microwave thermal ablation on the following day (Figure 4C). Follow-up CT (January 2012) showed good control of the dominant liver lesion without enhancement (Figure 4D); however, it also showed other metastatic hepatic lesions present (Figure 4E).