case_images: PMC9800099_01
case_images: Gallium-68 dotatate PET scan and corresponding abdominal CT. Gallium-68 dotatate PET demonstrates a focal area of radiotracer concentration in the distal pancreas consistent with a neuroendocrine tumor in the tail of the pancreas. Compared to CT imaging of the distal pancreas, there is a contour abnormality near the tail, suggesting a possible lesion.
case_images: CRIE2022-5472304.001.jpg
case_images: PMC9800099_01_CRIE2022-5472304.001.jpg
case_images: fig1
case_images: She had multiple imaging studies, including abdominal MRI and CT abdomen and pelvis, which had no significant findings except for a contour abnormality near the pancreatic tail identified by MRI imaging (Figure 1). Further testing using a gallium-68 dotatate PET scan demonstrated a focal area of radiotracer concentration in the distal pancreas, possibly consistent with a neuroendocrine tumor (Figure 1). There was a focal region of increased density of pancreatic islet cells, which was associated with mild chronic pancreatitis and thought to potentially represent the region identified by increased signal intensity on PET imaging studies (Figure 1).
case_images: Gross pathology demonstrating spleen and pancreas with a 0.6 x 0.6 x 0.3 cm pancreatic mass.
case_images: CRIE2022-5472304.002.jpg
case_images: PMC9800099_01_CRIE2022-5472304.002.jpg
case_images: fig2
case_images: A 0.6 x 0.6 x 0.3 cm pancreatic mass was identified (Figure 2).
case_images: Immunohistochemical staining for chromogranin-highlighted expanded islet cell nests with diffuse expansion of islets of Langerhans.
case_images: CRIE2022-5472304.003.jpg
case_images: PMC9800099_01_CRIE2022-5472304.003.jpg
case_images: fig3
case_images: Pathological analysis staining with chromogranin and synaptophysin highlighted expanded islet cell nests with diffuse expansion of islets of Langerhans and ductal insular complexes consistent with nesidioblastosis (Figures 3-5).
case_images: Immunohistochemical staining for synaptophysin-highlighted expanded islet cell nests.
case_images: CRIE2022-5472304.004.jpg
case_images: PMC9800099_01_CRIE2022-5472304.004.jpg
case_images: fig4
case_images: Pathological analysis staining with chromogranin and synaptophysin highlighted expanded islet cell nests with diffuse expansion of islets of Langerhans and ductal insular complexes consistent with nesidioblastosis (Figures 3-5).
case_images: Ductuloinsular complexes at 400X with synaptophysin staining.
case_images: CRIE2022-5472304.005.jpg
case_images: PMC9800099_01_CRIE2022-5472304.005.jpg
case_images: fig5
case_images: Pathological analysis staining with chromogranin and synaptophysin highlighted expanded islet cell nests with diffuse expansion of islets of Langerhans and ductal insular complexes consistent with nesidioblastosis (Figures 3-5).