Clinical Presentation

A 45-year-old woman presents with severe burning in the chest during meals. She is refractory to H 2 antagonists and omeprazole.

(A) Arterial-phase contrast-enhanced computed tomography (CT) shows an enhancing exophytic mass involving the body and tail of the pancreas (arrow) and an enhancing mass within the medial segment of the left lobe of the liver. (B) Arterial-phase contrast-enhanced CT shows multiple enhancing masses within the spleen and liver (arrows) and marked thickening and enhancement of the gastric wall (arrowhead).

Differential Diagnosis

• Gastrinoma: This is the overwhelming choice as the diagnosis because of the classic findings of a small, homogeneously enhancing pancreatic tumor, hypervascular liver metastases, and gastric fold thickening due to hyperstimulation by a gastrin-secreting tumor.

• Metastatic disease: