Pancreatic polypeptide-rich islets in the posterior portion of the pancreatic head--a tumor mimic in somatostatin receptor scintigraphy.
A 74-year-old man with recurrent duodenal ulcers underwent somatostatin receptor scintigraphy (SRS) in suspicion of gastrinoma. A 2-cm area of focal uptake was visualized within the pancreatic head. Serum chromogranin A levels were elevated, but serum gastrin levels and the secretin test were normal. Computed tomography and endoscopic ultrasonography were not conclusive. After partial duodenopancreatectomy, pathological examination failed to reveal any neuroendocrine tumor. Instead, the dorsal portion of the pancreatic head was found to be densely populated by pancreatic polypeptide cell-rich islets. This area correlated with the site of tracer uptake seen on SRS. Thus, pancreatic polypeptide cell-rich islets in elderly patients should be kept in mind when interpreting SRS results to avoid unnecessary major pancreatic resections.
From the *Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Marburg; and †Department of Pathology, Consultation Center for Pancreatic and Endocrine Tumors, Technical University of Munich, Munich, Germany.
Max Benjamin
MB
Albers
Elisabeth
E
Maurer
Günter
G
Klöppel
Detlef Klaus
DK
Bartsch
D000368:Aged; D001706:Biopsy; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D015282:Octreotide / Q000031:analogs & derivatives*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery; D050418:Pancreatic Polypeptide-Secreting Cells / Q000000981:diagnostic imaging* / Q000378:metabolism; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin / Q000378:metabolism*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; C094279:indium-111-octreotide; D015282:Octreotide