Case Report
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World J Radiol. Oct 28, 2014; 6(10): 840-845
Published online Oct 28, 2014. doi: 10.4329/wjr.v6.i10.840
Contrast enhanced multi-detector CT and MR findings of a well-differentiated pancreatic vipoma
Luigi Camera, Rosa Severino, Antongiulio Faggiano, Stefania Masone, Gelsomina Mansueto, Simone Maurea, Rosa Fonti, Marco Salvatore
Luigi Camera, Rosa Severino, Simone Maurea, Marco Salvatore, Department of Advanced Biomedical Sciences, Diagnostic Imaging Section, University “Federico II”, 80131 Naples, Italy
Luigi Camera, Rosa Fonti, Institute of Biostructures and Bioimaging (C.N.R.), 80131 Naples, Italy
Antongiulio Faggiano, Department of Clinical Medicine and Surgery, Endocrinology Section, University “Federico II”, 80131 Naples, Italy
Stefania Masone, Department of Gastro-enterology, Endocrinology and Surgery, University “Federico II”, 80131 Naples, Italy
Gelsomina Mansueto, Department of Advanced Biomedical Sciences, Pathology Section University “Federico II”, 80131 Naples, Italy
Author contributions: Camera L observed the case, designed the report and revised the manuscript; Severino R drafted the manuscript; Faggiano A was the referring physician; Masone S performed the laparotomy; Mansueto G performed histo-pathological and immuno-histochemical analysis; Maurea S performed the MR study; Fonti R performed the somatostatin receptor scintigraphy; Salvatore M edited the manuscript.
Correspondence to: Luigi Camera, MD, Department of Radiology, University “Federico II”, Via S. Pansini 5, 80131 Naples, Italy. camera@unina.it
Telephone: +39-81-7463560 Fax: +39-81-5457081
Received: May 7, 2014
Revised: September 18, 2014
Accepted: September 23, 2014
Published online: October 28, 2014
Processing time: 170 Days and 13.9 Hours
Abstract

Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms with a reported incidence of 0.1-0.6 per million. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography (CT) or magnetic resonance (MR) is pivotal for surgical planning. However, cross-sectional imaging findings are usually not specific and further characterization of the tumor may only be achieved by somatostatin-receptor scintigraphy (SRS). We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR (Somatom Trio 3T, Siemens, Germany). The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT (Aquilion 64, Toshiba, Japan) performed after i.v. bolus injection of only 100 cc of iodinated non ionic contrast media because of a chronic renal failure (3.4 mg/mL) but it was subsequently confirmed by SRS. The patient first underwent a successful symptomatic treatment with somatostatin analogues and was then submitted to a distal pancreasectomy with splenectomy to remove a capsulated whitish tumor which turned out to be a well-differentiated vipoma at histological and immuno-histochemical analysis.

Keywords: Pancreatic endocrine tumor; Vasoactive intestinal peptide; Multi-detector computed tomography; Contrast induced nephropathy; Magnetic resonance imaging; Nephrogenic systemic fibrosis; Somatostatin receptor scintigraphy

Core tip: Pancreatic vipoma is an extremely rare tumor accounting for less than 2% of endocrine pancreatic neoplasms. While cross-sectional imaging findings are usually not specific, exact localization of the tumor by means of either computed tomography (CT) or magnetic resonance (MR) is pivotal for surgical planning. We report the case of a 70 years old female with a two years history of watery diarrhoea who was found to have a solid, inhomogeneously enhancing lesion at the level of the pancreatic tail at Gadolinium-enhanced MR. The tumor had been prospectively overlooked at a contrast-enhanced multi-detector CT but it was subsequently confirmed by somatostatin-receptor scintigraphy. The patient first underwent a successful symptomatic treatment with somatostatin analogues and was then submitted to a distal pancreasectomy with splenectomy.