-Case Reports-

A Case of Nonfunctioning Pancreatic Endocrine Tumor with Atypical Imaging Findings due to Prominent Fibrosis of the Tumor Stroma

Arichika Hoshino^1,4, Takayuki Aimoto², Hideyuki Suzuki¹, Satoshi Mizutani¹, Yoshiharu Nakamura², Hideaki Ishii³, Seiichi Satoh^1,4, Hidemi Oba⁴, Tetsuo Sibuya^1,4 and Eiji Uchida²

¹Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
²Department of Gastrointestinal Surgery, Nippon Medical School
³Department of Pathology, Nippon Medical School
⁴Surgery, Sayama Chuo Hospital

The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein α was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.

J Nippon Med Sch 2014; 81: 346-352

Keywords
pancreatic endocrine tumor, desmoplastic stroma, tumor-associated fibroblasts

Correspondence to
Arichika Hoshino, Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
kuma-3@momo.so-net.ne.jp

Received, January 30, 2014
Accepted, March 10, 2014