PMC3038577_01
MD-CT scan demonstrating a hypodense lesion (arrow) with spots of peripheral calcifications in the body/tail of pancreas as wells as a large hypodense liver metastasis in the right lobe of liver, arrow (b). (c, d) show at endoscopic ultrasound the presence of the heterogeneous hypoechoic mass involving the body and tail of pancreas with numerous hypoechoic well defined peri-pancreatic lymph nodes (d).
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fig1
CT scan of abdomen revealed a 2.6 cm by 2.0 cm hypodense mass containing peripheral calcifications in the body of the pancreas (Figure 1). An endoscopic ultrasound (EUS) also found a 5- to 6-cm oval-shaped hypoechoic lesion (Figure 1) with irregular margins involving the left body and junction body/tail of the pancreas clearing invading the splenic artery with several hypoechoic large local lymph nodes.
US-guided liver biopsy staining H & E (a) demonstrating a rather uniform population of sheets of small cells arranged in manner (x40 in (b)). Immunohistochemistry with a Ki-67 marker (Mib-1) (c) estimated here to be 15% and positive immunostaining with chromogranin A (d).
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fig2
Histopathology from all sites confirmed neuroendocrine differentiation with diffuse chromogranin A and synaptophysin staining; the Ki-67 proliferation index varied form <2% in the pancreas to 10 to 15% in liver metastases (Figure 2).