PubMed · 6258700
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D J Sanders, C W Venables. 1981. Secretin provocation tests.. https://doi.org/10.1002/bjs.1800680324
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BACKGROUND: We retrospectively compared the accuracy of somatostatin receptor scintigraphy (SRS) with that of helical computed tomography (CT) in the detection and localization of primary and metastatic neuroendocrine tumors. METHODS: A medical record search identified 27 patients with known or clinically suspected neuroendocrine tumors who underwent helical CT and SRS within 3 months of one another at our institution. CT images were evaluated retrospectively by two blinded radiologists who used consensus reading. Images were evaluated for the presence or absence of primary tumor and hepatic and extrahepatic metastases. CT results were compared with the SRS report as interpreted by the nuclear medicine physicians. The results of the surgical, clinical follow-up, and pathologic findings were considered as the gold standard. Sensitivity, specificity, and accuracy were calculated for both imaging techniques. In addition, McNemar analysis was performed to determine statistically significant differences between CT and SRS. RESULTS: Helical CT was more sensitive than SRS in the detection of extrahepatic metastases, and the difference between the two imaging modalities was statistically significant (p = 0.0312) as determined by the McNemar chi-square test. However, the difference between CT and SRS in detecting primary neuroendocrine tumors, hepatic metastasis, and combined hepatic and extrahepatic metastasis was not statistically significant (p = 0.625, 1.000, and 1.000, respectively). CONCLUSION: Helical CT and SRS have similar sensitivity, specificity, and accuracy in detecting primary neuroendocrine tumor and hepatic metastasis. However, helical CT appears to be more sensitive in detecting extrahepatic metastasis from primary neuroendocrine tumors.
Islet cell tumors of the pancreas are uncommon, and nonfunctioning tumors are even rarer than functioning ones. We report the case of a 67-year-old woman with a small nonfunctioning islet cell tumor, 6 x 5 mm in diameter, which was detected incidentally by ultrasonography, and subsequently confirmed by double-helical computed tomography. Diagnosis was established by histopathological examination after 80% distal pancreatectomy with splenectomy, and by various laboratory tests. Histologically, the islet cell tumor showed highly cellular spindle or epithelioid cells, which were positive for Grimelius stain. Immunohistochemical examination revealed that the tumor cells were positive for chromogranin A, but negative for somatostatin, insulin, glucagon, and gastrin. Its small size, location, and benignity make this a very rare type of nonfunctioning islet cell tumor.
A rare case of symptomatic islet cell tumor arising from heterotopic pancreas in the duodenum with ulceration is described. Gastrointestinal bleeding was the only sign observed in this patient. Tagged red blood cell scan, upper endoscopy, and computed tomography scan showed active bleeding ulcer from a periampullary mass. Removal of the submucosal tumor was done to prevent future re-bleeding. Histologic and immunohistochemical characterization of the tumor showed an endocrine tumor that expressed a variety of endocrine peptides.