case_images: PMC4293551_01
case_images: (A) Abdominal computed tomography image. (B) No definite mass was found. Celiac arteriography shows the tumor (arrow) and the feeding artery (arrowheads) originating from the proximal splenic artery.
case_images: kjim-30-118-g001.jpg
case_images: PMC4293551_01_kjim-30-118-g001.jpg
case_images: F1
case_images: An abdominal CT scan did not indicate any definite pancreatic mass (Fig. 1A). A small hypervascular tumor in the pancreatic head and a feeding artery originating from the proximal portion of the splenic artery were observed (Fig. 1B).
case_images: Insulin (A) and C-peptide (B) levels in hepatic venous blood samples after selective arterial calcium stimulation of three major pancreatic arteries and the feeder artery. Insets depict insulin and C-peptide levels after calcium stimulation of three major pancreatic arteries. SMA, superior mesenteric artery; GDA, gastroduodenal artery; SPA, splenic artery; SPAf, the feeder artery from the splenic artery.
case_images: kjim-30-118-g002.jpg
case_images: PMC4293551_01_kjim-30-118-g002.jpg
case_images: F2
case_images: Serum insulin and C-peptide levels are shown in Fig. 2. The results showed remarkable increases in insulin and C-peptide secretion (Fig. 2), indicating that the tumor stained in the pancreatic head was an insulinoma.
case_images: (A-F) Immunohistochemical staining of the insulinoma (x200). Hematoxylin and eosin staining of the insulinoma is consistent with a neuroendocrine tumor (A). The proportion of Ki-67-positive cells (arrowheads) was 0.27% (15/5,524) of tumor cells (B). Most of the tumor cells stained positively for chromogranin (C), synaptophysin (D), insulin (E), and CD56 (F).
case_images: kjim-30-118-g003.jpg
case_images: PMC4293551_01_kjim-30-118-g003.jpg
case_images: F3
case_images: Immunohistochemical studies revealed that most of the tumor cells were positive for chromogranin, synaptophysin, insulin, and CD56, but negative for glucagon, somatostatin, carcinoembryonic antigen, and mucin-1 (Fig. 3).