PMC5364194_01
The radiological findings of a pancreatic tumor. A contrast-enhanced CT image of the abdomen demonstrating a lesion 15 mm in diameter in the pancreatic body (A: arrowhead). The tumor was strongly enhanced in the arterial phase (B: arrowhead) and slightly enhanced in the portal phase (C: arrowhead) and venous phase (D: arrowhead). T1-weighted (E) and T2-weighted (F) MRI and diffusion-weighted imaging (G) showed a lesion in the pancreatic body that had a low signal (arrowheads). The tumor was slightly enhanced in a gadolinium-enhanced image (H: arrowhead).
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Enhanced abdominal computed tomography (CT) was performed and showed a lesion 15 mm in diameter in the pancreatic body that was strongly enhanced in the arterial phase (Fig. 1A-D). Magnetic resonance imaging (MRI) of the abdomen showed a lesion in the pancreatic body, exhibiting a low signal on T1- and T2- images and slight enhancement on the Gd-enhanced image (Fig. 1E-H).
The pathological findings of the resected insulinoma. The pancreatectomy specimen contained a well-circumscribed white round mass 15 mm in diameter in the pancreatic body with the absence of a surrounding capsule (A: arrow). In Hematoxylin and Eosin staining, a well-differentiated tumor with amyloid deposition was observed histopathologically (B). The tumor had 1% Ki-67-positive cells per 10 HPFs and less than 2 mitoses per 10 HPFs. Immunostaining was positive for insulin (C). Immunostaining for synaptophysin (D) and chromogranin A (E) was also positive. The tumor was thus classified as a grade 1 neuroendocrine tumor based on the WHO classification.
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The resected specimen contained a well-circumscribed white round mass, 15 mm in diameter, in the pancreatic body with the absence of a surrounding capsule (Fig. 2A). The mass was pathologically found to be a well-differentiated tumor with amyloid deposition showing 1% Ki-67-positive cells and <2 mitoses (/10 high-power field (HPFs)) (Fig. 2B). Immunohistochemical studies showed positive staining for insulin and the neuroendocrine markers synaptophysin and chromogranin A but not for glucagon or gastrin (Fig. 2C-E), leading to the diagnosis of the insulinoma as a grade 1 neuroendocrine tumor based on the 2010 WHO Classification for Pancreatic Endocrine Neoplasms.
Clinical course. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization and the plasma and urinary adrenaline (AD) levels and noradrenaline (NA) level are shown. The levels of plasma NA and urinary NA were decreased after surgery. Although administration of losartan was discontinued 1 week after surgery, the SBP remained lower than 140 mmHg.
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Her systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization gradually normalized (Fig. 3).