PMC4967349_01
Point of care glucose trend during supervised fast. Our patient's point-of-care glucose monitoring during hospital admission showing a rapid decline to 40 mg/dl 6 h after initiation of fasting at 22:00
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Fig1
The patient became hypoglycemic overnight while fasting in less than 6 h (Fig. 1).
Result of MRI of the abdomen. Axial T1 weighted pre-contrast (a) and post-contrast (b) MRI images demonstrate a round enhancing lesion in the body of the pancreas (arrowhead)
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Fig2
An MRI of the abdomen revealed a 0.9 x 1.1 x 1.3 cm pancreatic mass (Fig. 2).
Gross and microscopic images of resected specimen. a Gross pancreatic specimen following laparoscopic distal pancreatectomy. External surface showing orange ink applied to the area in which a palpable mass was appreciated (circle). b Gross pancreatic body specimen showing cut surface with 1 cm hyperpigmented nodule (arrowhead), which presents a smooth surface distinct from adjacent normal lobulated pancreas. c Histologic section (H&E stain, 40x magnification) of the tumor showing an intact capsule separating it from normal pancreatic tissue. d Synaptophysin immunostain: diffuse positive staining present in tumor cells
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Fig3
She ultimately underwent laparoscopic distal pancreatectomy with pathologic examination of the mass confirming a benign insulinoma (Fig. 3).