Metastatic insulinoma
Presentation:
Hyperinsulinism.
Patient Data:
CT-scans shows a subtle hypervascular pancreatic lesion located at the junction of the body and tail of the pancreas, compatible with a neuroendocrine pancreatic tumor (pancreatic islet cell tumor).
Moreover, there are multiple liver lesions and pelvic carcinomatous nodules, indistinguishable from the ovaries.
Octreoscan done one month later shows excessive somatostatin liver & pancreatic receptors, compatible with a metastatic neuroendocrine tumor of pancreatic origin. There was a significant progression in this one month period follow-up.
MRI done two months later shows an important progression of liver metastases. The pancreatic lesions has grown and it shows heterogeneous enhancement following gadolinium administration. Pelvic carcinomatosis is not on this MRI.
Case Discussion:
There aren't many hypervascular pancreatic lesions except endocrine tumors of the pancreas. Apart from purely vascular lesions (aneurysm / pseudo-aneurysm), which should be easily identified on C+ studies, hypervascular metastases are amongst the only true differential diagnosis.
Related article:
*A special thanks to Dr Etienne Ouellet for sharing this case.
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