PMC1208966_01
Computed tomography scan of the abdomen revealed a large lesion of 5 to 6 cm in relation to the pancreatic body and tail (venous phase A, B, arrows).
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F1
While diagnostic tests repeatedly documented glucose levels below 40 mg/dl (normal levels 80 - 120 mg/dl), a computed tomography (CT) (Figure 1A, B) scan of the abdomen revealed a large lesion of around 5 to 6 cm in relation to the pancreatic body and tail.
Arterial phase of the computed tomography scan of the abdomen shows a hypervascularized area (arrows) in the pancreatic body.
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F2
Furthermore, in the pancreatic body there was a hypervascularized area (Figure 2), that was suspicious for an insulinoma.
Merkel cell carcinoma on the right eyebrow.
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F3
She gave a past history of an operation done on the right eyebrow 2 years prior for a 0.8 x 0.8 cm lesion (Figure 3) that was reported as a Merkel cell carcinoma.
Merkel cell carcinoma - primary tumor. A, B: Hematoxylin and eosin staining. A. Lower magnification showing intravasal tumor cells. B: Monomorphous tumor cells, pale staining nuclei, many mitotic figures. C: Strong cytokeratin 20 staining. Insert: Intravasal cytokeratin 20-positive tumor cells. D: Weak chromogranin A staining
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F4
Histopathology showed rather uniform tumor cells in a trabecular growth pattern (Figure 4a) with monomorphous pale-stained nuclei and many mitoses (Figure 4b). There was invasion of dermal lymphatics and blood vessels (Figure 4a, c, insert). A (Figure 4d).
Merkel cell carcinoma metastasis in the pancreas. A, B: Hematoxylin and Eosin staining. C: Synaptophysin staining. D: Cytokeratin 20 staining.
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F5
The proliferative activity (MIB-1) reached approximately 80% (Figure 5).
Insulinoma in the pancreatic body. A, B: Hematoxylin and Eosin staining. C: Insulin staining (note the focal positivity). D: Synaptophysin staining.
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F6
The proliferative activity (MIB-1) was approximately 1% (Figure 6).