Intraductal growth of a pancreatic glucagonoma

Abstract

A 72-year-old woman lost 10 kg during a 6-month treatment period for diabetes. She was given a diagnosis of pancreatic tumor by abdominal CT and referred to our hospital. A necrolytic migratory erythema (NME) was observed around the perineum and the knee. The laboratory investigations revealed normocytic anemia and hypoproteinemia. The glucagon level was elevated to 1,730 pg/ml. Enhanced abdominal CT showed a 3-cm diameter, mildly enhanced mass in the body of the pancreas. Endoscopic retrograde pancreatography showed interruption of the main pancreatic duct (MPD) in the head of the pancreas. Following the diagnosis of a pancreatic glucagonoma with an intraductal growth into the MPD, we performed distal pancreatectomy. A pathologic examination revealed a pancreatic neuroendocrine tumor, which was positive for immunohistochemical staining of chromogranin A, synaptophysin and glucagon. With a Ki-67 index of 1.7%, the tumor was identified as a neuroendocrine tumor, grade 1. We herein report a rare case of the intraductal growth of a pancreatic glucagonoma.