case_images: PMC10546301_01
case_images: (A) Abdominal plain and contrast MRI scans of the pancreas showed a lesion occupying the tail of the pancreas. (B) Abdominal plain and contrast MRI scans of the pancreas showed a lesion occupying the right adrenal gland and suspected as adenoma. (C) Histopathological image of tissue pancreas tumor removed. (D) MRI scan of the pituitary gland. (E) Emission computed tomography (ECT) images on parathyroid glands showed one radioactive uptake. (F) Postoperative pathology showed nodular hyperplasia of the parathyroid gland.
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case_images: PMC10546301_01_fendo-14-1175377-g001.jpg
case_images: f1
case_images: Abdominal computed tomography (CT) scan showed: (1) a lesion (38 mmx25 mm) occupying the tail of the pancreas ( Figure 1A ); (2) a lesion occupying the right adrenal gland and suspected as adenoma ( Figure 1B ); (3) small stones in the right kidney. G2 neuroendocrine tumor was finally diagnosed based on the pathological and immunohistochemical findings ( Figure 1C ). An uneven signal intensity was detected on the plain MRI scan of the pituitary gland, and no abnormal findings were detected on contrast scans ( Figure 1D ). The dual-phase 99mTc-MIBI parathyroid scan revealed a soft-tissue-density nodule behind the inferior pole of the right thyroid lobe, considering a hyperfunctioning parathyroid mass ( Figure 1E ). MEN1 by genetic testing ( Supplementary Figure 1 ), revealing a novel mutation c.1520delG>T (p.G507Afs*52) in exon 10 of MEN1 gene. Moreover, genetic testing was performed in the first-degree relatives of the patient, and the MEN1 gene mutation was detected in the patient's father, old brother and nephew ( Figure 2 ,  Supplementary Figure 1 ). The patient was treated with the surgical resection of the right inferior parathyroid gland in February 2022 in other hospital, and postoperative pathology showed nodular hyperplasia of the parathyroid gland ( Figure 1F ).
case_images: Pedigree diagram of the proband's family. Family members are indicated by generations (Roman numbers) and individuals (Arabic numbers). Circles indicated women and square indicated men. Clinical status was denoted: open symbols, normal; solid symbols affected.
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case_images: PMC10546301_01_fendo-14-1175377-g002.jpg
case_images: f2
case_images: Abdominal computed tomography (CT) scan showed: (1) a lesion (38 mmx25 mm) occupying the tail of the pancreas ( Figure 1A ); (2) a lesion occupying the right adrenal gland and suspected as adenoma ( Figure 1B ); (3) small stones in the right kidney. MEN1 by genetic testing ( Supplementary Figure 1 ), revealing a novel mutation c.1520delG>T (p.G507Afs*52) in exon 10 of MEN1 gene. Moreover, genetic testing was performed in the first-degree relatives of the patient, and the MEN1 gene mutation was detected in the patient's father, old brother and nephew ( Figure 2 ,  Supplementary Figure 1 ).
case_images: (A, B) Dual-phase 99mTc-MIBI parathyroid scan on parathyroid glands with three focal uptakes. (C, D) Ultrasound scan of parathyroid glands. (E, F) Complete hyperechoic area in the parathyroid glands indicated a complete ablation. (G ,H) Postoperative contrast enhanced ultrasound for parathyroid glands did not show blood flow in the remaining lesions.
case_images: fendo-14-1175377-g003.jpg
case_images: PMC10546301_01_fendo-14-1175377-g003.jpg
case_images: f3
case_images: Abdominal computed tomography (CT) scan showed: (1) a lesion (38 mmx25 mm) occupying the tail of the pancreas ( Figure 1A ); (2) a lesion occupying the right adrenal gland and suspected as adenoma ( Figure 1B ); (3) small stones in the right kidney. ECT images on the parathyroid glands in June 2022 showed two adjacent radioiodine uptake tissues (hyperparathyroidism tissues) on the dorsal side of the right thyroid lobe, and one suspected radioiodine uptake tissue on the dorsal side of the left upper thyroid lobe ( Figures 3A, B ). Ultrasound scan of parathyroid glands also showed a hypoechoic nodule in the lower posterior part of the right thyroid lobe (3.1 cmx0.9 cm) and a hypoechoic nodule in the left posterior lobe (0.93 cmx0.46 cm), suggesting benign nodules that may originate from the parathyroid gland ( Figures 3C, D ). The operation was sustained until the entire gland was hyperechoic ( Figures 3E, F ). After the ablation, color Doppler ultrasound and contrast-enhanced ultrasound were performed to confirm that no blood flow in the nodule and remaining lesions ( Figures 3G, H ).
case_images: Serum PTH and calcium levels before and after ultrasound-guided MWA. MWA, microwave ablation.
case_images: fendo-14-1175377-g004.jpg
case_images: PMC10546301_01_fendo-14-1175377-g004.jpg
case_images: f4