Adrenocorticotropic hormone-secreting pancreatic neuroendocrine carcinoma with multiple organ infections and widespread thrombosis: A case report

Figure 1 Contrast-enhanced abdominal computed tomography showing a 3-cm hypovascular lesion in the pancreatic tail. A: Arterial phase; B: Venous phase; C: Equilibrium phase.

Figure 2 Cytological images of endoscopic ultrasound-guided fine-needle aspiration showing cell clusters with high nuclear/cytoplasmic ratio. A: Cell clusters show non-specific structure after H-E staining; B: Immunostaining was positive for chromogranin A; C: Synaptophysin; D: CD 56; E: ACTH; and F: The Ki-67 index was approximately 40%.

Figure 3 Representative microphotographs showing hypercortisolemia-related infectious and thrombotic complications. A: Computed tomography revealed bilateral ground-glass opacities (GGO) on day 9; B: The area of GGO was spread, and new patchy consolidations were found in the right lobe on day 19; C: The area of GGO was decreased, and consolidation was observed in the sub-pleural regions suggesting the presence of organizing pneumonia on day 28; D and E: Computed tomography showing pulmonary thromboembolism.

Figure 4 Radioisotope studies, computed tomography, and magnetic resonance imaging. A: Somatostatin receptor scintigraphy using ¹¹¹In-pentetoreotide showed no uptake in the pancreatic tumor; B and C: Positron emission tomography using ¹⁸F-fluorodeoxyglucose showed uptake in the pancreatic tumor and the liver; D: The computed tomography scan performed before transfer to Mie University showed no lesion; E and F: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-magnetic resonance imaging also revealed multiple liver tumors suggesting metastases.