PMC8047461_01
(A) Abdominal computed tomography showed a pancreatic body tumor approximately 1.5 cm in size associated with liver tumors in the right and left lobes. Adrenal glands were normal without enlargement. (B) A suspected tumor at the pancreatic tail was disclosed on enhanced abdominal computed tomography (white arrow).
fendo-12-639967-g001.jpg
PMC8047461_01_fendo-12-639967-g001.jpg
f1
Subsequent abdominal CT showed a pancreatic body cystic tumor approximately 1.5 cm in size ( Figure 1A ) and a suspected pancreatic tail tumor associated with liver tumors in the right and left lobes ( Figure 1B ).
(A) MRI of the abdomen revealed a solid mass at the pancreatic tail with numerous liver tumors favoring metastases. The pancreatic body tumor was a cyst. (B) PET with MRI also showed peripancreatic lymph node metastases.
fendo-12-639967-g002.jpg
PMC8047461_01_fendo-12-639967-g002.jpg
f2
The pancreatic body tumor was a cyst ( Figure 2A ). Positron emission tomography (FDG-PET) with MRI also showed peripancreatic lymph node metastases ( Figure 2B ).
Abdominal computed tomography after 3 months of treatment with everolimus showed stationary pancreatic neuroendocrine tumors (A, white arrow) but decreasing liver metastasis nodule numbers (B), suggesting a partial response to everolimus.
fendo-12-639967-g003.jpg
PMC8047461_01_fendo-12-639967-g003.jpg
f3
After he took everolimus for three months and octreotide 3 times, and subsequent abdominal CT showed stationary pancreatic NETs but decreased liver metastasis nodule numbers, suggesting partial response to concurrent everolimus (  Figures 3A, B ).
Pathology from distal pancreatectomy showed a neuroendocrine tumor with numerous mitotic figures (A). Immunohistochemical analysis revealed that tumor cells were all positive for CD56, chromogranin A, synaptophysin, and beta-catenin on the membrane but negative for insulin. Ki-67 index was 15%. Therefore, it was a grade 2 neuroendocrine tumor (B).
fendo-12-639967-g004.jpg
PMC8047461_01_fendo-12-639967-g004.jpg
f4
Ki-67 index was 15% (  Figures 4A, B ).