case_images: PMC10687782_01
case_images: Ga 68 Exendin PET/CT: Showed diffuse uptake in the body and tail of pancreas.
case_images: autopsy-13-e2023451-g01.jpg
case_images: PMC10687782_01_autopsy-13-e2023451-g01.jpg
case_images: gf01
case_images: A functional scan with Gallium 68 exendin PET/CT was performed, and it showed diffuse tracer uptake in the entire pancreas with few foci of increased tracer uptake (- 1.6 *2.8 cm, SUV max 13.4) in the distal body and tail of the pancreas (Figure 1).
case_images: Photomicrographs of the pancreas. A and B - Diffuse proliferation of variably sized islet cells arranged in lobules and forming tubule-insular complex (red circle magnification); C and D - Enlarged Islet cells showing irregular nuclear contour, mildly enlarged nuclei with clear cytoplasm (H&E x400).
case_images: autopsy-13-e2023451-g02.jpg
case_images: PMC10687782_01_autopsy-13-e2023451-g02.jpg
case_images: gf02
case_images: Microscopic examinations showed maintained lobular exocrine pancreatic parenchyma architecture, with a proliferation of islet cells arranged in variably sized with lobulated patterns (Figures 2A and 2B). Individual cells were mildly irregular in shape with mildly increased size, centrally placed nuclei with a moderate amount of clear cytoplasm (Figures 2C and 2D).
case_images: Photomicrographs of the pancreas. Positive immunohistochemical reactions for A  - Chromogranin; B - Synaptophysin, C - ISNM-1.
case_images: autopsy-13-e2023451-g03.jpg
case_images: PMC10687782_01_autopsy-13-e2023451-g03.jpg
case_images: gf03
case_images: On immunohistochemistry, the enlarged and irregular islet cells were immune-reactive with chromogranin, synaptophysin, and Insulinoma-associated protein 1 (INSM1) (Figures 3A, 3B, and 3C).