PMC10359673_01
CT, SRS with SPECT/CT, and FDG-PET/CT findings of NEN tumor metastasis in primary pancreatic tail and #11p and #11d lymph nodes. a, b Contrast-enhanced CT showed a persistently enhanced mass measuring 20 x 25 mm in the pancreas tail (curved arrow), a significantly enlarged #11p node measuring 18 x 22 mm (short arrow), and vague findings in the #11d node measuring 8 x 10 mm (long arrow). c SRS with SPECT/CT showed abnormal uptake in the primary tail tumor (curved arrow) and #11p node (short arrow), whereas there was no abnormal uptake in #11d node (long arrow). d FDG-PET/CT showed mild FDG uptake with a maximum standardized uptake value (SUVmax) of 2.89 in the primary tail tumor (curved arrow) and mild uptake with an SUVmax of 3.42 in the #11p node (short arrow), whereas no uptake was seen in the #11d node (long arrow).
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F1
ProGRP in laboratory results were within normal limits. Preoperative contrast-enhanced CT showed a persistently enhanced mass in the pancreas tail that measured 20 x 25 mm (Fig. 1a,b), significantly enlarged #11p (18 x 22 mm) (Fig. 1a) and #18 (10 x 12 mm) lymph nodes (Fig. 2a), and an equivocal #11d node (8 x 10 mm) (Fig. 1a). Whole-body SRS with SPECT/CT scanning demonstrated abnormal uptake in the primary tail tumor (Fig. 1c), as well as the #11p (Fig. 1c) and #18 (Fig. 2b) nodes, while the #11d node showed no uptake in SRS findings (Fig. 1c). Whole-body FDG-PET/CT scanning showed mild FDG uptake with a maximum standardized uptake value of 2.89 in the primary tail tumor (Fig. 1d) and mild FDG uptake with a maximum standardized uptake value of 3.42 in the #11p node (Fig. 1d), with the #11d (Fig. 1d) and #18 (Fig. 2c) nodes showing no FDG uptake.
FDG-PET/CT and SRS with SPECT/CT findings of #18 lymph node metastasis. a Contrast-enhanced CT showed a significantly enlarged #18 node measuring 10 x 12 mm (arrow), suggesting nodal metastasis. b SRS with SPECT/CT showed abnormal uptake in the #18 node (arrow), suggesting nodal metastasis. c FDG-PET/CT showed no FDG uptake in the #18 node (arrow).
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F2
ProGRP in laboratory results were within normal limits. Preoperative contrast-enhanced CT showed a persistently enhanced mass in the pancreas tail that measured 20 x 25 mm (Fig. 1a,b), significantly enlarged #11p (18 x 22 mm) (Fig. 1a) and #18 (10 x 12 mm) lymph nodes (Fig. 2a), and an equivocal #11d node (8 x 10 mm) (Fig. 1a). Whole-body SRS with SPECT/CT scanning demonstrated abnormal uptake in the primary tail tumor (Fig. 1c), as well as the #11p (Fig. 1c) and #18 (Fig. 2b) nodes, while the #11d node showed no uptake in SRS findings (Fig. 1c). Whole-body FDG-PET/CT scanning showed mild FDG uptake with a maximum standardized uptake value of 2.89 in the primary tail tumor (Fig. 1d) and mild FDG uptake with a maximum standardized uptake value of 3.42 in the #11p node (Fig. 1d), with the #11d (Fig. 1d) and #18 (Fig. 2c) nodes showing no FDG uptake.
Resected specimen and pathologic findings of primary tumor. a A tumor occupying nearly all of the pancreatic tail was revealed in the resected specimen. b Hematoxylin and eosin staining of a section of the specimen showed tumor cells small to intermediate in size, which had formed sheets and nests, and contained small round hyperchromatic nuclei with indistinct nucleoli and scanty cytoplasm. c-e Immunohistochemical findings with chromogranin A (c) and synaptophysin (d) were positive, while the Ki-67 index (e) was 5%. f Immunohistochemical findings with SSTR were positive.
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F3
Physicians at the Department of Hepato-Biliary-Pancreatic Surgery performed a laparoscopic resection of the pancreatic body and tail (Fig. 3a), plus dissection of abdominal lymph nodes, which included #8 (common hepatic artery nodes), #10 (splenic hilum nodes), #11 (splenic artery nodes), and #18 (inferior pancreatic nodes). A pathologic examination of the tail tumor, sized 20 x 23 mm, revealed a PNET with tumor cells small to intermediate in size, which had formed sheets and nests (G2) (Fig. 3b). Immunohistochemical findings with chromogranin A, synaptophysin, and somatostatin were positive, and the Ki-67 index was 5% (Fig. 3c-e). SSTR results of the primary tumor (Fig. 3f) showed positive staining, indicating three metastatic nodes: all of #11p, part (6 x 6 mm) of #11d, and all of #18 (Fig. 4a-c).