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ClinicalA 59-year-old female presented to diabetes clinic with a 1.5-year history of episodes of confusion and syncope with two random blood glucose measurements found to be <40 mg/dL (normal 70-99 mg/dL). A triple phase pancreatic protocol CT and abdominal MRI were negative.Upper endoscopic ultrasound (EUS) was performed and a mass seen (Figure 1). Endoscopic fine needle biopsy obtained abnormal cells (Figure 2). Figure 1. 7.5MHz Radial EUS image showing an 7mm hypoechoic lesion in the body of the pancreas (arrow) Figure 2. Cytologic specimen with a cluster of cells containing ovoid nuclei with a fine chromatin pattern (Romanovsky stain, 00d7600) What is the diagnosis? Answer

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hsi-Che Shen, Superintendent, Taipei County Hospital, Taipei County, Taiwan, and Instructor, Taipei Medical University, Taipei, Taiwan; Tsu-Tuan Wu and Sheng-Hsiang Lin, Pulmonary Specialists, Department of Internal Medicine, Taipei County Hospital, Taipei County, Taiwan

Acknowledgements

Correspondence

Sheng-Hsiang Lin, Department of Internal Medicine, Taipei County Hospital, No.2, Chung-Shan Rd., San-Chong City, Taipei County 24141, Taiwan.

Correspondence Email

linsh01@gmail.com

Competing Interests

- Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology. 2000;216(1):163-171.-- Kirkeby H, Vilmann P, Burcharth F. Insulinoma diagnosed by endoscopic ultrasonography-guided biopsy. J Laparoendosc Adv Surg Tech A. 1999;9(3):295-298.-- Proye C, Malvaux P, Pattou F, et al. Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery. 1998;124(6):1134-1143; discussion 1143-1144.-- McLean A. Endoscopic ultrasound in the detection of pancreatic islet cell tumours. Cancer Imaging. 2004;4(2):84-91.-- Ardeng JC, Rosenbaum P, Gang JA, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc. 2000;51(5):552-555.-- Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992:326(26):1721-1726.-- Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B. Pancreatic tumors: Evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994;190(3):745-751.-- Mougey AM, Adler DG. cNeuroendocrine Tumors: Review and Clinical Update.d Hospital Physician. 2007;43(11):12-20, 51.-

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ClinicalA 59-year-old female presented to diabetes clinic with a 1.5-year history of episodes of confusion and syncope with two random blood glucose measurements found to be <40 mg/dL (normal 70-99 mg/dL). A triple phase pancreatic protocol CT and abdominal MRI were negative.Upper endoscopic ultrasound (EUS) was performed and a mass seen (Figure 1). Endoscopic fine needle biopsy obtained abnormal cells (Figure 2). Figure 1. 7.5MHz Radial EUS image showing an 7mm hypoechoic lesion in the body of the pancreas (arrow) Figure 2. Cytologic specimen with a cluster of cells containing ovoid nuclei with a fine chromatin pattern (Romanovsky stain, 00d7600) What is the diagnosis? Answer

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hsi-Che Shen, Superintendent, Taipei County Hospital, Taipei County, Taiwan, and Instructor, Taipei Medical University, Taipei, Taiwan; Tsu-Tuan Wu and Sheng-Hsiang Lin, Pulmonary Specialists, Department of Internal Medicine, Taipei County Hospital, Taipei County, Taiwan

Acknowledgements

Correspondence

Sheng-Hsiang Lin, Department of Internal Medicine, Taipei County Hospital, No.2, Chung-Shan Rd., San-Chong City, Taipei County 24141, Taiwan.

Correspondence Email

linsh01@gmail.com

Competing Interests

- Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology. 2000;216(1):163-171.-- Kirkeby H, Vilmann P, Burcharth F. Insulinoma diagnosed by endoscopic ultrasonography-guided biopsy. J Laparoendosc Adv Surg Tech A. 1999;9(3):295-298.-- Proye C, Malvaux P, Pattou F, et al. Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery. 1998;124(6):1134-1143; discussion 1143-1144.-- McLean A. Endoscopic ultrasound in the detection of pancreatic islet cell tumours. Cancer Imaging. 2004;4(2):84-91.-- Ardeng JC, Rosenbaum P, Gang JA, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc. 2000;51(5):552-555.-- Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992:326(26):1721-1726.-- Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B. Pancreatic tumors: Evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994;190(3):745-751.-- Mougey AM, Adler DG. cNeuroendocrine Tumors: Review and Clinical Update.d Hospital Physician. 2007;43(11):12-20, 51.-

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

ClinicalA 59-year-old female presented to diabetes clinic with a 1.5-year history of episodes of confusion and syncope with two random blood glucose measurements found to be <40 mg/dL (normal 70-99 mg/dL). A triple phase pancreatic protocol CT and abdominal MRI were negative.Upper endoscopic ultrasound (EUS) was performed and a mass seen (Figure 1). Endoscopic fine needle biopsy obtained abnormal cells (Figure 2). Figure 1. 7.5MHz Radial EUS image showing an 7mm hypoechoic lesion in the body of the pancreas (arrow) Figure 2. Cytologic specimen with a cluster of cells containing ovoid nuclei with a fine chromatin pattern (Romanovsky stain, 00d7600) What is the diagnosis? Answer

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Hsi-Che Shen, Superintendent, Taipei County Hospital, Taipei County, Taiwan, and Instructor, Taipei Medical University, Taipei, Taiwan; Tsu-Tuan Wu and Sheng-Hsiang Lin, Pulmonary Specialists, Department of Internal Medicine, Taipei County Hospital, Taipei County, Taiwan

Acknowledgements

Correspondence

Sheng-Hsiang Lin, Department of Internal Medicine, Taipei County Hospital, No.2, Chung-Shan Rd., San-Chong City, Taipei County 24141, Taiwan.

Correspondence Email

linsh01@gmail.com

Competing Interests

- Ichikawa T, Peterson MS, Federle MP, et al. Islet cell tumor of the pancreas: biphasic CT versus MR imaging in tumor detection. Radiology. 2000;216(1):163-171.-- Kirkeby H, Vilmann P, Burcharth F. Insulinoma diagnosed by endoscopic ultrasonography-guided biopsy. J Laparoendosc Adv Surg Tech A. 1999;9(3):295-298.-- Proye C, Malvaux P, Pattou F, et al. Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery. 1998;124(6):1134-1143; discussion 1143-1144.-- McLean A. Endoscopic ultrasound in the detection of pancreatic islet cell tumours. Cancer Imaging. 2004;4(2):84-91.-- Ardeng JC, Rosenbaum P, Gang JA, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc. 2000;51(5):552-555.-- Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992:326(26):1721-1726.-- Muller MF, Meyenberger C, Bertschinger P, Schaer R, Marincek B. Pancreatic tumors: Evaluation with endoscopic US, CT, and MR imaging. Radiology. 1994;190(3):745-751.-- Mougey AM, Adler DG. cNeuroendocrine Tumors: Review and Clinical Update.d Hospital Physician. 2007;43(11):12-20, 51.-

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