Pancreatic Struma with Papillary Thyroid Carcinoma: a Diagnostic Dilemma

Excerpt

A 34-year-old female presented with constant dull ache and a fullness sensation in the right upper, right lower, and left lower quadrants of the abdomen. Magnetic imaging performed in 2007 identified an 8.9 × 8.4 × 8.6 cm heterogeneous enhancing mass arising from the pancreatic body, extending into the pancreatic head and uncinate process (Fig. 1), resulting in a mass effect on portal venous confluence with collateral vessel formation. There was no distal pancreatic ductal dilatation. An additional heterogeneous enhancing lesion with similar enhancement characteristics was seen in segments 5/6 of the liver measuring 3.5 × 4.5 cm (Fig. 1). The lesions demonstrated avid enhancement on the arterial phase examination with some washout of the portal venous and delayed phase examinations. Diagnostic imaging identified this to be consistent with a pancreatic neuroendocrine tumor. Biochemical tests were negative. She underwent an octreotide scan which demonstrated uptake in the pancreatic lesion but not at the site of the liver lesion. The lesion did not progress during surveillance for 7 years. In 2014, the patient opted to undergo surgical resection of the pancreatic mass and partial hepatectomy including segments 5 and 6 as well as cholecystectomy.

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