A 12-year-old MN West Highland white terrier was presented for evaluation of tremors, hypoglycemia, and an insulin glucose ratio of 239.
A 12-year-old MN West Highland white terrier was presented for evaluation of tremors, hypoglycemia, and an insulin glucose ratio of 239.
Right pancreatic nodule, suspect insulinoma. Possible nodular hyperplasia, yet given the patient’s history it should be presumed that the right pancreatic nodule would be insulinoma.
Concurrent pyloric hypertrophy. There was no evidence of metastatic disease.
A 0.8 cm hypoechoic nodule was noted at the right pancreatic base. This would be consistent with insulinoma, but must be confirmed surgically. It may be difficult to obtain a solid FNA sample for a definitive diagnosis, yet this could be attempted with ultrasound-guided measures.
Pyloric hypertrophy was noted with some retention of ingesta. The remainder of the intestinal tract was unremarkable.
Intraoperative ultrasound would be recommended in order to identify the nodule given its excessively small size. Gastric biopsy could be justified at the time of surgery given the pyloric hypertrophy and to rule out underlying concurrent disease that may be causing delayed outflow. The pancreatic nodule is positioned approximately 0.5 cm caudal from the pyloric anthrum and just cranial to the transverse colon (see images attached). In the area of the nodule the parenchymal detail is lost, which would meet neoplastic criteria. There was no evidence of metastatic disease.
Insulinoma
