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Refractory Metastatic Insulinoma Treated with Everolimus, Complicated by Cryptogenic Organizing Pneumonia

Charles J. Kim, Devon McKenzie, Joe K. Joseph, Yasemin Aytaman, Milay Luis Lam, Lina Soni, Samy I. McFarlane

American Journal of Medical Case Reports. 2019, 7(7), 125-132 doi:10.12691/ajmcr-7-7-2
  • Figure 1a. The mass to the left lateral aspect of the uncinated process extends along the superior portion of the distal transverse duodenum and adjacent to the superior mesenteric artery measures 28 x 17mm maximal cross-sectional diameter. Although this is immediately adjacent to the superior mesenteric artery fat plane, the superior mesenteric artery is maintained
  • Figure 1b. 6 mm hypodensity in the R hepatic lobe. 1c. Retroperitoneal LAD of 1.4 cm
  • Figure 2. MRI abdomen w/ and w/o contrast. 2a. T1 isointense signal which may represent the patient's primary neoplasm given history of insulinoma. There is extensive bulky peripancreatic lymphadenopathy which extends along the root of the mesentery and encases the superior mesenteric artery inferior to the pancreas. Bulky and enlarged bilateral renal hilar lymph nodes are present measuring up to 2.9 cm. 2b: T2 sequence of coronal section of MRI abdomen/pelvis showing liver metastasis
  • Figure 3. Histology of Liver metastasis from metastatic insulinoma showing carcinoid-type metastatic neuroendocrine tumors (negative for gastrin/insulin/somatostatin)
  • Figure 4. Progression of diffuse, scattered consolidations/nodularity with surrounding ground glass opacifications, which was diagnosed as
  • Figure 5. Lung biopsy showing cryptogenic organizing pneumonia, non-necrotizing granulomatous inflammation, and reactive epithelial changes. 20x magnification