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This 71 y/o male presented with abdominal pain. An initial workup, including CT of the abdomen was unremarkable. After 3 months of persistent abdominal pain a repeat CT of the abdomen was performed. Selected images from that abdominal CT shown above demonstrate a subtle decreased attenuation mass in the head of the pancreas impinging on the inferior vena cava. A CT guided percutaneous biopsy was performed and yielded "atypical cells consistent with malignancy, carcinoma of pancreas vs. malignant lymphoma". Further characterization of the tumor was not possible on the sample submitted. An open surgical resection was performed and the tissue was determined to be consistent with a "neuroendocrine carcinoma" after immunohistochemical evaluation and outside pathologic consultation. Presumably this is a "non-functioning" neuroendocrine tumor as all studies for neuroendocrine function were negative - or - are available studies for neuroendocrine function too crude to detect subtle or intermittent tumor function??

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