An unusual case of subclinical diffuse glucagonoma coexisting with two nodules in the pancreas: Characteristic features on computed tomography - 01/06/12

Doi : 10.1016/j.clinre.2011.12.003

N. Azemoto ^a, T. Kumagi ^b,^⁎ , T. Yokota ^c, T. Kuroda ^b, M. Koizumi ^b, H. Yamanishi ^b, Y. Soga ^d, S. Furukawa ^b, M. Abe ^b, Y. Ikeda ^a, Y. Hiasa ^b, B. Matsuura ^b, J. Watanabe ^e, F. Kushihata ^e, M. Onji ^b
^a Endoscopy Center, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
^b Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
^c Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
^d Pathology Division, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan
^e Hepato-biliary-pancreatic Surgery and Transplantation, Ehime University Graduate School of Medicine, Toon, Japan

Corresponding author. Tel.: +81 89 960 5308; fax: +81 89 960 5310.

Summary

A lesion was discovered in the tail of the pancreas by ultrasonography performed during a health checkup for a 59-year-old Japanese man. Abdominal contrast-enhanced computed tomography (CE-CT) revealed strong enhancement in a 4-cm tumor in the pancreatic tail and in a 1-cm tumor in the pancreatic body. Serum glucagon levels were elevated to 54,405pg/mL and a preoperative diagnosis of glucagonoma was made. The pancreatic tail and spleen were resected en bloc, along with a protruding tumor in the pancreatic body. However, histopathological evaluation revealed diffuse glucagonoma throughout the pancreas. When we retrospectively reviewed abdominal CE-CT after the operation, the entire pancreas was seen to be enlarged and diffusely enhanced by strong spots. Immunohistochemical examination using anti-CD31 demonstrated rich microvessels in two solid glucagonomas as well as microglucagonoma throughout the entire pancreas, indicating hypervascularity. Enlarged pancreas and diffuse enhancement of the pancreas by strong spots may be characteristic features of diffuse glucagonoma on abdominal CE-CT.

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