PMC7688994_01
Ultrasound and CT imaging of mass. A. Predominately solid mass (arrow) associated with the pancreatic neck/body measuring 3.4 x 4.0 x 2.8 cm with no clear pancreatic ductal dilatation. B. Neck of pancreas mass on Endoscopic Ultrasound (EUS). C. CT showing solid or cystic mass within the neck of the pancreas measuring 3.9 cm x 3.7 cm, hyperenhancing relative to the background pancreatic parenchyma. No evidence of distal pancreatic ductal dilatation.
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Unexpectedly, the ultrasound identified a predominantly solid lesion associated with the pancreatic neck that measured 3.4 x 4.0 x 2.8 cm (Fig. 1A) which was confirmed on endoscopic ultrasound (Fig. 1B). CT imaging re-demonstrated the pancreatic mass as a large solid or cystic hyper-enhancing mass within the neck of the pancreas measuring 3.9 cm x 3.7 cm (Fig. 1C).
Macroscopic appearance of neuroendocrine tumor.. A. After surgical removal, ink was applied to the surface of the resected specimen to delineate surgical margins prior to sectioning. After removal of the surgical staples and sutures, the specimen was bisected to reveal a solid, multinodular tumor surrounded by a rim of dense connected tissue. B. Pictural diagram of resection and construction of pancreatojejunostomy anastomosis.
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The patient subsequently underwent resection of mass via central pancreatectomy with pancreticojejunostomy reconstruction for remnant distal pancreas (Fig. 2a and 2b [pictural diagram]).
Histology of pancreatic neuroendocrine tumor.. A. Upper panel (10x original magnification) revealed a well circumscribed and monotonous neuroendocrine neoplasia arranged in nests and cords of tumor cells separated by a delicate fibrovascular stroma. B. Lower panel (20x original magnification) reveals nests of neuroendocrine tumor cells characterized by round to slightly elongated nuclei, finely granular (salt-and-pepper chromatin pattern, inconspicuous nucleoli, and a scant to moderate amount of pale eosinophilic cytoplasm. (hematoxylin and eosin stain).
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Immunostains for CD25+ cells (interleukin-2 receptor alpha chain, present on aberrant mast cells) positive for mast cell tryptase were present in both the tumor and the adjacent unaffected pancreas (Fig. 3, Fig. 4).