Because symptoms are non-specific, diagnosis is often delayed. Measurement of hormones including pancreatic polypeptide, gastrin, proinsulin, insulin, glucagon, and vasoactive intestinal peptide can determine if a tumor is causing hypersecretion. Multiphase CT and MRI are the primary modalities for morphologic imaging of<unk> s. While MRI is superior to CT for imaging, both of the primary tumor and evaluation of metastases, CT is more readily available. Notably, while many malignant lesions are hypodense in contrast-enhanced studies, the liver metastases of<unk> s are hypervascular and readily visualized in the late arterial phase of the post-contrast CT study. However, morphological imaging alone is not sufficient for a definite diagnosis On biopsy, immunohistochemistry is generally positive for chromogranin and synaptophysin. Genetic testing thereof typically shows altered MEN1 and DAXX/ATRX.
Pancreatic neuroendocrine tumor
Small intestine neuroendocrine tumor
Metastatic insulinoma
Acinar cell carcinoma of the pancreas
Glucagonoma
Pancreatic mucinous cystic neoplasm
Insulinoma
Goblet cell carcinoid