Medical image. A case of recurrent hypoglycaemia
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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
Acknowledgements
Correspondence
Correspondence Email
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
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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
Acknowledgements
Correspondence
Correspondence Email
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
Acknowledgements
Correspondence
Correspondence Email
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.-
Contact diana@nzma.org.nz
for the PDF of this article
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
Acknowledgements
Correspondence
Correspondence Email
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.-
Contact diana@nzma.org.nz
for the PDF of this article
Medical image. A case of recurrent hypoglycaemia
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