PMC6582874_01
MRI abdomen showing diffuse gastric wall thickening (4.52 cm) with a small pancreatic cystic lesion (arrows).
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Subsequently, an extensive workup for evaluation of MEN was done, which revealed a unilateral parathyroid adenoma on neck imaging and diffuse stomach wall thickening along with pancreatic cystic lesions in body (1.2 cm) and tail (0.7 cm) on abdominal MRI (Figure 1).
EGD showing LA grade D esophagitis in the distal esophagus (a), hypertrophic rugae in the gastric body (b), and multiple postbulbar ulcers in third part of the duodenum (c), as indicated by arrows.
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An esophagogastroduodenoscopy (EGD) was performed for further evaluation of her symptoms, which revealed severe reflux esophagitis, diffusely hypertrophic gastric rugae and multiple postbulbar ulcers in the duodenum (Figures 2(a), 2(b), and 2(c)).
EUS showing hypertrophic gastric rugae (a) and neuroendocrine tumor in the pancreatic neck (b), respectively, as indicated by arrows.
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I-III (Figure 3(a)). In addition, the patient was found to have a cystic lesion in the pancreatic neck with thick hypoechoic walls (Figure 3(b)).
Gastric biopsy (a) showing patchy hypertrophic gastritis and intestinal metaplasia (green arrows) while pancreatic aspirate (b) showing neuroendocrine cells (area enclosed within circle).
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Random biopsies of the gastric antrum and body revealed patchy chronic gastritis with intestinal metaplasia (Figure 4(a)) while FNA from pancreatic cyst revealed well differentiated NET (Figure 4(b)).