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  #1  
Old 07-31-2011
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Question Diagnose the mass in Pancreas

A 38-year-old woman has experienced episodes of light-headedness, irritability, and difficulty concentrating at her work for the past year. On physical examination there are no abnormal findings. Laboratory studies show her hemoglobin is 14.2 g/dL. An abdominal CT scan shows a 1 cm mass in the tail of the pancreas. Which of the following is the most likely diagnosis?

A Carcinoid tumor

B Insulinoma

C Adenocarcinoma

D Pseudocyst

E Pheochromocytoma

F Neuroendocrine carcinoma
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  #2  
Old 07-31-2011
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b) insulinoma light headedness and unable to concentrate due to hypoglycemia...excess secretion of insulin

Last edited by docusmle9; 08-01-2011 at 10:05 AM.
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Old 07-31-2011
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maybe insulinoma
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Old 07-31-2011
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I agree

insulinoma.......
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Old 08-01-2011
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Why not C. Adenocarcinoma???
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Old 08-01-2011
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i'm between b and d
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Old 08-01-2011
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i think his symptoms show hypoglucemia so insulinoma seems likely
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Old 08-01-2011
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yea it seems like insulinoma
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Old 08-01-2011
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Quote:
Originally Posted by usmle2011 View Post
A 38-year-old woman has experienced episodes of light-headedness, irritability, and difficulty concentrating at her work for the past year. On physical examination there are no abnormal findings. Laboratory studies show her hemoglobin is 14.2 g/dL. An abdominal CT scan shows a 1 cm mass in the tail of the pancreas. Which of the following is the most likely diagnosis?

A Carcinoid tumor

B Insulinoma

C Adenocarcinoma

D Pseudocyst

E Pheochromocytoma

F Neuroendocrine carcinoma
wts the ans??
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Old 08-01-2011
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lightheadedness so i ll go with insulinoma
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  #11  
Old 08-02-2011
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Default Explanation

(A) Incorrect. Carcinoid tumors are histologically similar to islet cell tumors. Carcinoids are more common in the intestine. A carcinoid this small is unlikely to produce enough 5HIAA to produce symptoms of flushing, headache, and diarrhea with carcinoid syndrome.

(B) CORRECT. A variety of hormones can potentially be elaborated by islet cell adenomas, but the most common is insulin, leading to hypoglycemia. This hypoglycemia may occur periodically. Often, the adenoma is so small that it is difficult to detect by radiologic imaging techniques.

(C) Incorrect. Adenocarcinoma of the pancreas is malignant and unlikely to be such a small, circumscribed mass. The most common paraneoplastic syndrome associated with adenocarcinoma is Trousseau syndrome causing a hypercoagulable state.

(D) Incorrect. Pseudocysts occur as a complication of pancreatitis, which produces abdominal pain. Pseudocysts are a focus of necrotizing inflammation and have irregular borders.

(E) Incorrect. Pheochromocytomas can produce headaches with hypertension from catecholamine release. Most arise in the adrenal medulla. The pancreas is not a site for extra-adrenal pheochromocytoma.

(F) Incorrect. Neuroendocrine carcinomas of the GI tract are not common, and most arise in the colon. Their poor differentiation makes them unlikely to produce endocrine effects.
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