PMC5659828_01
A: magnetic resonance imaging performed in the non-contrasting T1 sequence, showing an enlarged and irregular expansive lesion of the pancreas tail (red arrow) and thickening of the left adrenal (blue arrow). B: magnetic resonance imaging performed in the contrasting T1 sequence. C: nodular lesion in segment VI of the liver (yellow arrow).
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III and increased volume of both adrenals (Figure 1). In January 2014, he was referred to our institution, the Instituto do Cancer do Estado de Sao Paulo, where he underwent an R0 body-caudal pancreatectomy, splenectomy and removal of the segment III of the liver, which was compatible with PNET, infiltrating the liver tissue.
Hyperpigmented lesions of his tongue and nails likely caused by increased propiomelanocortin (POMC) prohormone production, which is cleaved into ACTH and MSH, inducing darkening of the skin and nails. The strips in his nails timely occurred when the tumour responded to CApOx
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At this time, he presented diffuse exuberant hyperpigmented lesions of the skin, mainly in interphalangeal joints and tongue (Figure 2).