eMedicine Specialties > Oncology > Carcinomas of Endocrine Organs

Neoplasms of the Endocrine Pancreas: Multimedia

Author: Eric J Hanly, MD, Resident, Department of Surgery, The Johns Hopkins University School of Medicine; Fellow, Department of Surgery, The Johns Hopkins University School of Medicine
Coauthor(s): Ozanan R Meireles, MD, Research Fellow in Minimally Invasive Surgery, Department of Surgery, Johns Hopkins University School of Medicine; Michael R Marohn, DO, Associate Professor, Department of Surgery and Surgical Sciences, John Hopkins University School of Medicine; Charles J Yeo, MD, Samuel D Gross Professor and Chair of Surgery at Jefferson Medical College of Thomas Jefferson University and at Thomas Jefferson University Hospital; Keith D Lillemoe, MD, Professor and Chairman, Department of Surgery, Indiana University School of Medicine; Lisa H McGrail, MD, Associate Chief, Department of Hematology/Oncology, Malcolm Grow Medical Center
Contributor Information and Disclosures

Updated: Jun 29, 2006

Multimedia

Neoplasms of the endocrine pancreas. CT scan imag...
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Media file 1: Neoplasms of the endocrine pancreas. CT scan image with oral and intravenous contrast in a patient with biochemical evidence of insulinoma. The 3-cm contrast-enhancing neoplasm (arrow) is seen in the tail of the pancreas (P) posterior to the stomach (S) (Yeo, 1993).
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Neoplasms of the endocrine pancreas. CT scan imag...

Neoplasms of the endocrine pancreas. CT scan image with oral and intravenous contrast in a patient with biochemical evidence of insulinoma. The 3-cm contrast-enhancing neoplasm (arrow) is seen in the tail of the pancreas (P) posterior to the stomach (S) (Yeo, 1993).

Neoplasms of the endocrine pancreas. Celiac axis ...
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Media file 2: Neoplasms of the endocrine pancreas. Celiac axis angiography in the same patient as in Image 1. Contrast is seen opacifying the common hepatic artery (CHA) and splenic artery (SA). The superior pancreatic artery (arrow) is seen as an early U-shaped branch of the splenic artery.
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Neoplasms of the endocrine pancreas. Celiac axis ...

Neoplasms of the endocrine pancreas. Celiac axis angiography in the same patient as in Image 1. Contrast is seen opacifying the common hepatic artery (CHA) and splenic artery (SA). The superior pancreatic artery (arrow) is seen as an early U-shaped branch of the splenic artery.

Neoplasms of the endocrine pancreas. Highly selec...
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Media file 3: Neoplasms of the endocrine pancreas. Highly selective distal angiography in the same patient as in images 1 and 2. With the arterial catheter now advanced into the superior pancreatic artery, the contrast blush of this vascular tumor is easily seen (arrows).
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Neoplasms of the endocrine pancreas. Highly selec...

Neoplasms of the endocrine pancreas. Highly selective distal angiography in the same patient as in images 1 and 2. With the arterial catheter now advanced into the superior pancreatic artery, the contrast blush of this vascular tumor is easily seen (arrows).

Neoplasms of the endocrine pancreas. Intravenous ...
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Media file 4: Neoplasms of the endocrine pancreas. Intravenous and oral contrast-enhanced CT scan image in a patient with chronic diarrhea and elevated levels of serum vasoactive intestinal peptide. In the venous phase of this scan, the splenic vein (SV) is clearly seen draining the 5-cm tumor (T) located anteromedial to the spleen (S) in the tail of the pancreas.
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Neoplasms of the endocrine pancreas. Intravenous ...

Neoplasms of the endocrine pancreas. Intravenous and oral contrast-enhanced CT scan image in a patient with chronic diarrhea and elevated levels of serum vasoactive intestinal peptide. In the venous phase of this scan, the splenic vein (SV) is clearly seen draining the 5-cm tumor (T) located anteromedial to the spleen (S) in the tail of the pancreas.

Neoplasms of the endocrine pancreas. Schematic di...
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Media file 5: Neoplasms of the endocrine pancreas. Schematic diagram of provocative angiography. Access to the central venous and arterial systems is obtained through cannulation of a femoral vein and a femoral artery. In the selective arterial secretin stimulation test, secretin is injected selectively into the splenic, gastroduodenal (a branch of the common hepatic), and inferior pancreaticoduodenal (a branch of the superior mesenteric) arteries with concomitant and subsequent hepatic venous sampling for gastrin. Based on the level of gastrin in each hepatic venous sample, the location of the gastrinoma is arterially mapped. An analogous method can be used in the selective arterial calcium stimulation test to determine the location of occult insulinomas that respond to calcium stimulation by secreting insulin.
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Neoplasms of the endocrine pancreas. Schematic di...

Neoplasms of the endocrine pancreas. Schematic diagram of provocative angiography. Access to the central venous and arterial systems is obtained through cannulation of a femoral vein and a femoral artery. In the selective arterial secretin stimulation test, secretin is injected selectively into the splenic, gastroduodenal (a branch of the common hepatic), and inferior pancreaticoduodenal (a branch of the superior mesenteric) arteries with concomitant and subsequent hepatic venous sampling for gastrin. Based on the level of gastrin in each hepatic venous sample, the location of the gastrinoma is arterially mapped. An analogous method can be used in the selective arterial calcium stimulation test to determine the location of occult insulinomas that respond to calcium stimulation by secreting insulin.

Neoplasms of the endocrine pancreas. Graphic depi...
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Media file 6: Neoplasms of the endocrine pancreas. Graphic depiction of the results of a selective arterial secretin stimulation test in a patient with an occult gastrinoma. The gastrin gradient (the rise in hepatic vein gastrin concentration divided by the basal value) is plotted over time. An increase in gastrin gradient from 0 to 2 thus represents a 200% rise compared to the basal level. A significant rise in hepatic vein gastrin concentration is observed both after the injection of secretin into the superior mesenteric artery (SMA) and after secretin injection into the gastroduodenal artery (GDA), but no such increase occurs following secretin injection into the splenic artery (SPL). This patient's neoplasm is thus localized to the head of the pancreas or the duodenum
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Neoplasms of the endocrine pancreas. Graphic depi...

Neoplasms of the endocrine pancreas. Graphic depiction of the results of a selective arterial secretin stimulation test in a patient with an occult gastrinoma. The gastrin gradient (the rise in hepatic vein gastrin concentration divided by the basal value) is plotted over time. An increase in gastrin gradient from 0 to 2 thus represents a 200% rise compared to the basal level. A significant rise in hepatic vein gastrin concentration is observed both after the injection of secretin into the superior mesenteric artery (SMA) and after secretin injection into the gastroduodenal artery (GDA), but no such increase occurs following secretin injection into the splenic artery (SPL). This patient's neoplasm is thus localized to the head of the pancreas or the duodenum

Neoplasms of the endocrine pancreas. Octreotide s...
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Media file 7: Neoplasms of the endocrine pancreas. Octreotide scan (anterior view) in a patient with a pancreatic endocrine tumor. The large pancreatic-tail neoplasm is seen retaining tracer in the patient's left upper quadrant. Several tracer-enhancing hepatic metastases are seen in the patient's right upper quadrant and epigastrium. Tracer is also seen in the bladder following renal excretion (round density in the hypogastrium) (Yeo, 2001).
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Neoplasms of the endocrine pancreas. Octreotide s...

Neoplasms of the endocrine pancreas. Octreotide scan (anterior view) in a patient with a pancreatic endocrine tumor. The large pancreatic-tail neoplasm is seen retaining tracer in the patient's left upper quadrant. Several tracer-enhancing hepatic metastases are seen in the patient's right upper quadrant and epigastrium. Tracer is also seen in the bladder following renal excretion (round density in the hypogastrium) (Yeo, 2001).

Neoplasms of the endocrine pancreas. CT scan with...
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Media file 8: Neoplasms of the endocrine pancreas. CT scan with oral and intravenous contrast in a patient with a glucagon-secreting neoplasm. This 10-cm contrast-enhancing tumor (T) is seen obliterating the normal appearance of the tail of the pancreas (Yeo, 2001).
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Neoplasms of the endocrine pancreas. CT scan with...

Neoplasms of the endocrine pancreas. CT scan with oral and intravenous contrast in a patient with a glucagon-secreting neoplasm. This 10-cm contrast-enhancing tumor (T) is seen obliterating the normal appearance of the tail of the pancreas (Yeo, 2001).

Neoplasms of the endocrine pancreas. Endoscopic u...
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Media file 9: Neoplasms of the endocrine pancreas. Endoscopic ultrasonography in a patient with an insulinoma. The hypoechoic neoplasm (arrows) is seen in the body of the pancreas anterior to the splenic vein (SV) (Rosch, 1992).
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Neoplasms of the endocrine pancreas. Endoscopic u...

Neoplasms of the endocrine pancreas. Endoscopic ultrasonography in a patient with an insulinoma. The hypoechoic neoplasm (arrows) is seen in the body of the pancreas anterior to the splenic vein (SV) (Rosch, 1992).

More on Neoplasms of the Endocrine Pancreas

Overview: Neoplasms of the Endocrine Pancreas
Differential Diagnoses & Workup: Neoplasms of the Endocrine Pancreas
Treatment & Medication: Neoplasms of the Endocrine Pancreas
Follow-up: Neoplasms of the Endocrine Pancreas
Multimedia: Neoplasms of the Endocrine Pancreas
References
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Further Reading

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Keywords

pancreatic cancer, pancreas cancer, pancreatic neoplasm, pancreas neoplasm, pancreatic islet cell tumor, pancreatic islet cell adenoma, pancreatic endocrine tumor, pancreatic neuroendocrine tumor, insulinoma syndrome, insulinoma, Zollinger-Ellison syndrome, ZES, gastrinoma syndrome, gastrinoma, Verner-Morrison syndrome, WDHA syndrome, watery diarrhea, hypokalemia, achlorhydria, pancreatic cholera, vasoactive intestinal peptide-releasing tumor, VIPoma, glucagonoma syndrome, somatostatinoma syndrome, calcitoninoma, parathyrinoma, growth hormone releasing facto-secreting tumor, GRFoma, adrenocorticotropin hormone-secreting tumor, ACTHoma, neurotensinoma, pancreatic endocrine neoplasm, pancreatic polypeptidomas, PPomas, islet cell tumor, pancreatic cholera, MEN 1 syndrome, MEN-I syndrome, MEN-1 syndrome, multiple endocrine neoplasia type 1, multiple endocrine neoplasia type I, MEN syndrome, APUDomas

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Contributor Information and Disclosures

Author

Eric J Hanly, MD, Resident, Department of Surgery, The Johns Hopkins University School of Medicine; Fellow, Department of Surgery, The Johns Hopkins University School of Medicine
Eric J Hanly, MD is a member of the following medical societies: American Medical Association, Association of Military Surgeons of the US, MedChi, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Ozanan R Meireles, MD, Research Fellow in Minimally Invasive Surgery, Department of Surgery, Johns Hopkins University School of Medicine
Ozanan R Meireles, MD is a member of the following medical societies: American College of Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons
Disclosure: Nothing to disclose.

Michael R Marohn, DO, Associate Professor, Department of Surgery and Surgical Sciences, John Hopkins University School of Medicine
Disclosure: Nothing to disclose.

Charles J Yeo, MD, Samuel D Gross Professor and Chair of Surgery at Jefferson Medical College of Thomas Jefferson University and at Thomas Jefferson University Hospital
Charles J Yeo, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Endocrine Surgeons, American College of Surgeons, American Gastroenterological Association, American Hepato-Pancreato-Biliary Association, American Surgical Association, Association for Academic Surgery, Johns Hopkins Medical and Surgical Association, Pancreas Club, Phi Beta Kappa, Sigma Xi, Society for Surgery of the Alimentary Tract, and Society of University Surgeons
Disclosure: Nothing to disclose.

Keith D Lillemoe, MD, Professor and Chairman, Department of Surgery, Indiana University School of Medicine
Disclosure: Nothing to disclose.

Lisa H McGrail, MD, Associate Chief, Department of Hematology/Oncology, Malcolm Grow Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Michael C Perry, MD, Professor, Department of Internal Medicine, Nellie B Smith Chair of Oncology, Director, Division of Hematology and Oncology, University of Missouri at Columbia/Ellis Fischel Cancer Center
Michael C Perry, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, Missouri State Medical Association, Southern Association for Oncology, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, American Society for Therapeutic Radiology and Oncology, and American Society of Clinical Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

John S Macdonald, MD, Professor of Medicine, New York Medical College; Chief, Division of Medical Oncology, St Vincent's Hospital and Medical Center; Medical Director, Saint Vincent's Comprehensive Cancer Center
Disclosure: Nothing to disclose.

 
 
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