PMC8337156_01
Hyperattenuating lesion in the anterior plane of the head of the pancreas (2.4 cm x 2.3 cm x 2.1 cm), bilateral adrenal hyperplasia, and nonvisualization of the left kidney.
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Contrast-enhanced computed tomography (CECT) abdomen showed a hyperattenuating lesion in the pancreatic head (2.4 cm x 2.3 cm x 2.1 cm) communicating with the main pancreatic duct and bilateral adrenal hyperplasia (Figure 1).
99mTc MIBI scan showing right inferior parathyroid adenoma.
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Likewise, technetium-99m labeled hexakis-methoxyisobutyl isonitrile (99mTc MIBI) scan showed right inferior parathyroid adenoma (Figure 2).
Postoperative specimen.
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Classical pancreaticoduodenectomy (Whipple's procedure) was performed which showed 3 cm x 2 cm fleshy mass present in the pancreatic head (Figure 3) with no ascites, the pancreas was soft, and common bile duct measured about 12 mm.
Well-differentiated neuroendocrine tumor; tumor cells arranged in trabeculae, cords, and lobules with vascular septa. These cells show mild nuclear atypia, fine stippled chromatin, inconspicuous nucleoli, and moderate amount of eosinophilic granular cytoplasm. Mitosis is infrequent (H&E X100).
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Histopathological examination (HPE) revealed a well-differentiated neuroendocrine tumor (Figure 4) with a maximum tumor dimension of about 2.6 cm with lymph node metastasis.