Final Diagnosis -- Incidental Glucagonoma (Liver Transplant)

FINAL DIAGNOSIS:

PART 1: ALLOGRAFT LIVER (1620 GRAMS), ORTHOTOPIC LIVER

TRANSPLANTATION -

A. MASSIVE COAGULATIVE NECROSIS EXTENSIVELY INVOLVING

HEPATIC PARENCHYMA (microbial stains to follow).

B. PORTAL VEIN AND HEPATIC ARTERIAL THROMBOSIS.

C. STATUS POST CHOLECYSTECTOMY.

PART 2: DISTAL PANCREAS, PARTIAL RESECTION -

A. PANCREAS WITH FOCAL AREAS OF HEMORRHAGE AND FAT

NECROSIS (microbial stains to follow).

B. SPLENIC VEIN AND ARTERIAL THROMBOSIS.

C. INCIDENTAL ISLET CELL ADENOMA (0.2 CM DIAMETER).

PART 3: ALLOGRAFT LIVER, RIGHT LOBE, NEEDLE BIOPSY -

A. MILD CENTRILOBULAR HEPATOCELLULAR NECROSIS.

B. NO EVIDENCE OF ACUTE CELLULAR REJECTION AND NO

VIRAL INCLUSIONS SEEN.

PART 4: ALLOGRAFT LIVER, LEFT LOBE, NEEDLE BIOPSY -

A. COAGULATIVE HEPATOCELLULAR NECROSIS INVOLVING

APPROXIMATELY 50% OF THE SAMPLED PARENCHYMA.

B. NO EVIDENCE OF ACUTE CELLULAR REJECTION AND NO

VIRAL INCLUSIONS SEEN.

ADDENDUM #2

(1 Chromogranin, 1 Synaptophysin, 1 Insulin, 1 Somatostatin, 1 Glucagon)

Immunohistochemical evaluation of the islet cell microadenoma reveals positive immunostaining with synaptophysin, chromogranin, and glucagon with negative reactions with insulin and omatostatin. These results are consistent with an incidental "glucagonoma".