Contributed by Karen K Deal, MD, PhD and Uma N. M. Rao, MD
Published on line in November 1998
The patient is a 72-year old man diagnosed two years ago with prostatic adenocarcinoma, Gleason Grade 6. He received radiation therapy at that time but did no undergo surgery. Recently, his prostate specific antigen (PSA) increased from 1 to 7.7. He subsequently underwent a metastatic workup. A bone scan was negative, but a computerized tomography scan revealed a 6 cm mass in the tail of the pancreas. Blood chemistries seven months prior were entirely normal, but recent fasting glucose levels were in the range of 50-60 mg/dl. The patient complained of vague left flank pain, but denied fainting spells, diarrhea, nausea/vomiting, or weight loss. Significant medical history includes coronary artery disease and a non-Q wave myocardial infarction in 1972.
A CT-guided needle biopsy of the pancreas performed at an outside institution revealed ill-defined nests of cells separated by vascularized stroma, which stained strongly positive for chromogranin and synaptophysin and focally positive for cytokeratin. A subsequent octreotide (a long-acting somatostatin analogue) scan was equivocal.