case_images: PMC11381282_01
case_images: (A) Initial treatment in May 2020, an enhanced CT scan of the upper abdomen shows an irregular area of increased soft tissue density in the body and tail of the pancreas, approximately 7.6 x 3.1 cm (indicated by a red arrow). Multiple lesions are present in the liver (indicated by yellow arrows). (B) Follow-up in August 2022, an enhanced CT scan of the upper abdomen reveals the irregular area of increased soft tissue density in the body and tail of the pancreas has changed slightly, measuring about 7.3 x 3.6 cm (red arrow). Multiple liver lesions are observed, with the largest located in the left lobe of the liver, approximately 17 x 13 x 6.3 cm. The lesion in the right lobe has increased in size compared to earlier, measuring about 3.9 x 4.0 cm (yellow arrow). (C) Preoperative check in February 2023, an enhanced CT scan of the upper abdomen shows the irregular soft tissue density lesion in the body and tail of the pancreas, approximately 7.5 x 4.0 cm (red arrow). The largest lesion in the liver, located in the left lobe, measures approximately 17.5 x 13.5 x 7 cm, showing progression from the previous scans (yellow arrow). (D) Clinic follow-up in August 2023, an enhanced CT scan of the upper abdomen after surgery shows the absence of the body and tail of the pancreas, spleen, gallbladder, and parts of the liver. Multiple nodular lesions of slightly lower density are observed in the remaining liver parenchyma, with the largest lesion measuring about 3.1 x 4.2 cm (yellow arrow).
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case_images: f1
case_images: Multiple liver lesions of varying sizes and slightly lower densities were also noted ( Figure 1A ) A liver tumor biopsy considering a neuroendocrine tumor G2, immunohistochemistry showed positive for Syn and CgA, weakly positive for CD56, and negative for Hepatocyte, Glypican-3, Arginase-1, CK7, with a Ki-67 of 3% ( Figure 2A ). The lesion in the upper segment of the right anterior lobe had increased in size, measuring approximately 3.9 x 4.0 cm ( Figures 1B ). Multiple liver lesions of varying sizes and densities were observed, the largest in the left lobe of the liver measuring approximately 17.5 x 13.5 x 7 cm, showing progression ( Figure 1C ). Enlarged lymph nodes in the abdominal and retroperitoneal areas were more pronounced than before, considered metastatic changes ( Figure 1D ).
case_images: (A) H&E staining of a liver metastasis. (B) Postoperative histological staining of a pancreatic tumor section.
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case_images: f2
case_images: Multiple liver lesions of varying sizes and slightly lower densities were also noted ( Figure 1A ) A liver tumor biopsy considering a neuroendocrine tumor G2, immunohistochemistry showed positive for Syn and CgA, weakly positive for CD56, and negative for Hepatocyte, Glypican-3, Arginase-1, CK7, with a Ki-67 of 3% ( Figure 2A ). Figure 2B ). Five days post-surgery, the patient's skin lesions began to crust and flake off ( Figure 3B ).
case_images: (A) Preoperative lower limb skin lesion. (B) Lower limb skin lesion, 5 days postoperative. (C) Lower limb skin lesion, six months postoperative.
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case_images: f3
case_images: There were multiple scattered rashes on the mouth, buttocks, back, and both lower limbs, with those on the legs being larger, approximately 5 cm in diameter, some of which were confluent ( Figure 3A ). Figure 2B ). Five days post-surgery, the patient's skin lesions began to crust and flake off ( Figure 3B ). As of April 2024, the patient's general condition was good, with no significant skin symptoms during the period ( Figure 3C ).
case_images: February 23, 2023 - Resection of the pancreatic body and tail, splenectomy, and hepatic tumor resection (approximately 90%), postoperative specimen.
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case_images: f4
case_images: On February 23, 2023, the patient underwent resection of the pancreatic body and tail, splenectomy, partial hepatectomy, and cholecystectomy under general anesthesia ( Figure 4 ).