case_images: PMC6515007_01
case_images: Showing serum pancreatic polypeptide (PP) levels (pg/mL) over time. Octreotide treatment was initiated in February 2014. Since initiation of octreotide treatment, the PP levels remain stable. Reference range PP (0.0-418.0 pg/mL).
case_images: CRIGM2019-9462942.001.jpg
case_images: PMC6515007_01_CRIGM2019-9462942.001.jpg
case_images: fig1
case_images: The patient refused any treatment initially; 11 months later the serum pancreatic polypeptide levels rose to 1198 pg/mL (range 912-1588), and 5 weeks later the value was 1215 pg/mL (Figure 1). Following the octreotide treatment, the serum pancreatic polypeptide levels normalized to 62 pg/mL in approximately 6 weeks (Figure 1). Additionally, the serum pancreatic polypeptide levels remained within normal limits (91.6 pg/mL) (Figure 1).
case_images: CT of the pancreas showing three hyperenhancing lesions. (a) 4 mm lesion in the inferior aspect of the pancreatic tail (blue arrow). (b) 9 mm lesion in the superior aspect of the pancreatic tail (red arrow). (c) 10 mm lesion in the pancreatic head (white arrow). (d) Coronal view revealing both pancreatic tail lesions (arrow heads).
case_images: CRIGM2019-9462942.002.jpg
case_images: PMC6515007_01_CRIGM2019-9462942.002.jpg
case_images: fig2
case_images: At this time a repeat CT scan showed 3 hyperenhancing lesions in the head and tail of the pancreas measuring 10, 9, and 4 mm (Figure 2).
case_images: CT of the pancreas showing three hyperenhancing lesions which have remained stable 38 months after initiating octreotide. (a) Stable 4 mm tumor in the inferior aspect of the pancreatic tail (blue arrow). (b) Stable lesion in the superior aspect of the pancreatic tail (red arrow). (c) Stable lesion in the pancreatic head.
case_images: CRIGM2019-9462942.003.jpg
case_images: PMC6515007_01_CRIGM2019-9462942.003.jpg
case_images: fig3
case_images: These lesions correlated with 111-Indium Octreotide scan (Figure 3).
case_images: Gallium-68 DOTATATE PET/CT scan showing stability of the pancreatic tumors over time.
case_images: CRIGM2019-9462942.004.jpg
case_images: PMC6515007_01_CRIGM2019-9462942.004.jpg
case_images: fig4
case_images: A most recent gallium-68 DOTATATE PET/CT scan (Figure 4) performed 3 years later, while the patient was on octreotide therapy, further confirmed the stability of the pancreatic lesions.