Metastatic insulinoma

Case contributed by Dr Maxime St-Amant

Presentation

Hyperinsulinism.

Patient Data

Age: 35 years
Gender: Female
CT

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.

Nuclear medicine

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

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 seen 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.

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Case information

rID: 19080
Case created: 5th Aug 2012
Last edited: 30th Jan 2016
Inclusion in quiz mode: Included

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