Presentation
Presented to the emergency department for severe left upper quadrant pain and diarrhea for about 6 months. Severe duodenal ulceration on upper endoscopy.
Patient Data
There is a heterogeneously enhancing 4 x 5 cm mass in the head of the pancreas.
Case Discussion
Endoscopic ultrasound with transgastric fine needle aspiration of the mass showed synaptophysin and chromogranin positive neuroendocrine cells consistent with gastrinoma.
Gastrin level was 3600 (normal 0-180).
The patient proceeded to a Whipple procedure and the path showed:
Well differentiated neuroendocrine tumor, WHO grade 2, 4.8 cm, confined to the pancreas. Fewer than 2 mitoses/10 high-power fields (HPF); number of mitoses per 10 HPF: 2
No lymphovascular or perineural invasion identified.
pT2: Tumor limited to the pancreas, more than 2 cm in greatest dimension
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