Sandbox: DDx 2

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DDX 1

Differential Diagnosis Key Symptoms Characteristic Lab Findings CT Scan Characteristic Histopathological Features

Insulinoma

  • Diaphoresis
  • Tremor
  • Palpitations
  • Seizures
  • Coma
  • Hypoglycemia
  • Hyperinsulinemia
  • Elevated C-peptide level
  • Elevated Pro-insulin level
  • Calcification and hyperattenuation of the mass
  • Solid or gyriform cellular patterns
  • Amyloid deposition
  • Nesidioblastosis may be present
  • Absence of glands

VIPoma

  • Watery diarrhea
  • Dehydration
  • Lethargy
  • Muscle weakness
  • Flushing
  • Elevated (VIP) levels
  • Elevated neurotensin levels
  • Hypokalemia
  • Hypomagnesaemia
  • Hypercalcaemia
  • Metabolic acidosis
  • Hypervascularity with diffuse multiple metastatic nodulation
  • Solid sheets
  • Uniform cuboidal cells
  • Centrally located nuclei
  • Stippled chromatin
  • Granular eosinophilic cytoplasm

Gastrinoma

  • Epigastric abdominal pain
  • Diarrhea
  • Heartburn
  • Hematemesis
  • Elevated serum gastrin level
  • Positive secretin stimulation test
  • Small hypoattenuating nodule ± calcification
  • Lobular-trabecular pattern
  • Gastrin+ tumor cells
  • Infiltration of Brunner glands