Benign Solitary Research Articles

An atypical manifestation of a common familiar tumour: the unforeseen occurrence of osteochondroma

A solitary osteochondroma in the lesser trochanter is an exceedingly rare occurrence. The nature of osteochondromas as benign osteocartilaginous tumours is typically regarded as a developmental anomaly rather than a neoplastic condition. Patients afflicted with this condition may experience a range of symptoms dependent upon the size of the tumour, with limited range of motion being a common manifestation. The present case study pertains to a distinctive instance of a benign solitary osteochondroma of the lesser trochanter, which was diagnosed and treated through an excisional biopsy using a Hardinge approach.

Epidemiological, Clinical, and Histopathological Features of the Head and Neck Region Schwannomas-Our Experience in the Western Part of Romania with Surgical Insights.

Schwannomas are benign solitary, slow-growing, encapsulated, asymptomatic tumors arising from Schwann's sheath of nervous fibers. The current paper presents all the cases diagnosed with different types of schwannomas in the head and neck region between January 2009 and December 2023 in the Western part of Romania. In this period, ten cases of schwannoma were identified. The pathological exams were performed at the Department of Pathology using morphological Hematoxylin-Eosin staining. In addition, immunohistochemical reactions were used in order to confirm the diagnosis. Demographic and clinical data, imaging features, surgical approach, and morphological and immunohistochemical aspects are presented. The results also display an impressive clinical picture of a gigantic ancient schwannoma. This retrospective study describes our experience with head and neck schwannomas, the diagnostic methods available, the surgical decisions, and the histopathological aspects while analyzing the data and reviewing the published specialized literature in the English language.

Benign Solitary Schwannoma of the Cheek: A Case Report and a Review of the Literature.

Schwannomas are generally known to be benign tumors that arise from Schwann cells. The most frequently encountered tumors of this type in ENT are vestibular schwannomas or acoustic neuromas. However, head and neck localization, although rare, has been documented in the literature. We present the case of a 13-year-old girl who presented with chronic swelling of the left cheek, leading to aesthetic discomfort. Clinical examination objectified a palpable swelling on both the external and internal sides of the left cheek. No other abnormalities were detected during the clinical examination. Ultrasound of the soft tissues identified the left cheek swelling as corresponding to a subcutaneous cyst. No further investigations were indicated for this patient. The treatment consisted of surgical excision via an intraoral approach with an internal buccal incision. Histological analysis confirmed the diagnosis of schwannoma. Schwannoma, a benign neurologic tumor, is rarely located in the face, particularly in the jaw. Its diagnosis is confirmed through histopathological examination, and treatment typically involves complete surgical removal when feasible.

6981 Atypical hypoglycemia in a teenage boy with prediabetes

Abstract Disclosure: N. Shahid: None. C. salgado: None. N. Gurtunca: None. Background: Hypoglycemia in teenagers is seen less commonly than in younger children. Overweight children with prediabetes presenting with hypoglycemia symptoms are often considered to have reactive post-prandial hypoglycemia due to the degree of hyperinsulinemia with insulin resistance seen in these children. We present a 13-year-old boy with prediabetes, who presented with episodes of altered mental status and was found to have hypoglycemia due to a solitary insulin secreting tumor. Case presentation: A 13-yr old boy with pre-diabetes presented to the ER with altered consciousness and non-ketotic, non-acidotic hypoglycemia [25 mg/dl] & trace ketonuria in the setting of Influenza A infection. Weight and BMI above the 99th%ile and acanthosis nigricans in the skin creases. No access to oral hypoglycemic agents. Urine toxicology was negative. EEG was normal. Euglycemia and level of consciousness restored after IV dextrose & this was considered a possible hypoglycemic seizure episode secondary to poor oral intake. 4 months later he had another episode of altered mental status, jittery movements and was found to be hypoglycemic [41 mg/dl]. He was admitted for further workup of recurrent hypoglycemia. Adrenal insufficiency was ruled out and a diagnostic fast was started. After 15 hours, he developed non-ketotic hypoglycemia [<50 mg/dl]. Critical sample [Table 1] and Glucagon challenge [Table 2] at the termination of the fast confirmed hyperinsulinemic hypoglycemia. Given the unusual age and presentation, an MRI abdomen was done which showed a 1.6 cm lesion in the pancreatic body [Fig 1]. Dotatate whole body PET scan confirmed the insulinoma with no evidence of nodal or distant metastasis [Fig 2]. He underwent surgical enucleation of the insulinoma. Intraoperative secretin showed no evidence of pancreatic duct dilatation or leakage. Hereditary endocrine tumor panel including multiple endocrine neoplasia [MEN] gene analysis was negative. The postoperative course was complicated by a persistent pancreatic leak and pancreatitis eventually requiring an ERCP and stent placement 2 months post operatively. Conclusion: Insulinomas are very rare neuroendocrine tumors in pediatric population, with a prevalence of one in 250,000 and median age at presentation of 45-50 years. About 90% insulinomas are benign and less than 10% are associated with MEN-1 syndrome. Chronic hypoglycemia irrespective of the underlying insulin resistance of prediabetes can be seen with insulinoma and can cause hypoglycemia unawareness as seen in our patient. This has also been reported in literature to be misdiagnosed as refractory epilepsy or psychiatric disorders. Hypoglycemic symptoms at any age should be promptly worked up. Ruling out associated neuroendocrine hereditary tumor syndromes is crucial and prognosis of benign solitary insulinomas after surgical removal is mostly favorable. Presentation: 6/3/2024

A common tumour at an uncommon location: Lesser trochanter osteochondroma

Osteochondromas are benign osteocartilaginous tumours, which are developmental abnormalities rather than actual neoplasms. The lesser trochanter is an extremely rare location for a solitary osteochondroma, and depending on the tumour’s size, the patient can exhibit various symptoms, including a limited range of motion. This case study describes a rare instance of a benign solitary osteochondroma of the lesser trochanter identified and managed using an excisional biopsy following Ludloff’s approach. With intraoperative fluoroscopy, we could accurately outline and remove the entire tumour mass without endangering the nearby essential tissues.

Massive spontaneous hemothorax caused by benign solitary schwannoma

Massive spontaneous hemothorax caused by benign solitary schwannoma

MULTIPLE INTRACRANIAL MENINGIOMAS: A CASE REPORT AND A LITERATURE REVIEW

Multiple intracranial meningiomas refer to the presence of multiple meningiomas in multiple intracranial locations in the same patient without signs of neurofibromatosis. The incidence varies from 1% to 10%. Despite the diversity, the prognosis of multiple intracranial meningiomas has no difference from that of benign solitary meningioma. However, malignant tumors of different grades are observed to occur simultaneously in one-third of multiple meningiomas. Surgery is still the best choice for the treatment of symptomatic lesions. Our case review aims to introduce and discuss a 50-year-old female patient diagnosed with multiple intracranial meningiomas, and to describe its clinical, radiological, and histological characteristics. It also emphasizes that the patient had four tumors, underwent surgery, and had a good long-term overcome.

Reactive Gingival Lesions, Investigations, And Treatment Modalities: Review Article

Background and Objectives: Reactive gingival lesions (RGLs) are benign solitary swellings frequently responding to chronic inflammation of gingiva precipitated by local irritation. The research article was designed to discuss clinical and pathological features, and treatment options of RGLs. These lesions are generally clinically similar but histologically different. Various treatment modalities have been used, including surgical blade excision, laser surgical techniques, electrosurgery and cryosurgery. Laser surgeries present more benefits, especially for the hemorrhagic and vascularized lesions in comparison to others. Conclusions: The incidence of RGLs are secondary precipitated to tissue damage and local irritating factors which are like benign rather than malignant masses. Clinical and histological investigations are designated to classify the nature of RGLs. Improvement of oral health, besides complete removal of local irritants through professional periodic care and maintaining oral cleaning measures, is necessary to avoid the recurrence of these lesions.

Antrochoanal Polyp and Migrated Dental Implant in the Ipsilateral Maxillary Sinus.

Antrochoanal polyp is usually a benign solitary mass lesion originated from maxillary sinus mucosa and emerging through maxillary ostium. We report a rare case of antrochoanal polyp and migrated dental implant in the ipsilateral maxillary sinus. Clinicians should be aware that ACP may have other concomitant conditions such as migrated dental implants.

Clinical results after surgical resection of benign solitary schwannomas: A review of 150 cases

IntroductionPeripheral nerve schwannomas are the most common nerve tumors. While they are efficiently treated with surgery, the risk of neurological complications, especially sensory deficits, remains debated. HypothesisWe postulate that rates of post-operative sensory deficits in peripheral schwannoma surgery are low and are not increased in schwannomas of the hand, in which preservation of discriminative tact is of prime functional importance. Materials and methodsA retrospective multicenter study was carried out on 150 patients with an isolated peripheral schwannoma operated between 2002 and 2018, including 11 patients with schwannomas of the hand. All cases were reviewed preoperatively and postoperatively with a detailed exam of the neurological status. ResultsMost schwannomas were located in the lower limbs (58%). The two main affected trunks were the posterior tibial nerve in the lower limb and the median nerve in the upper limb. The average preoperative tumor volume measured on MRI was 2.93 cm3 [0.11 cm3–25 cm3]. The most common preoperative symptoms were paresthesia (77.1%) and pseudo-Tinel sign (55.7%). Less frequently, pain (50.3%) and hypoesthesia (18.1%) were observed. On the other hand, preoperative neurological motor manifestations remained exceptional (3.3%). The rates of new post-operative motor deficits, paresthesias, and sensory deficits were 4.6%, 10.9% and 8% respectively and were not increased in schwannomas of the collateral nerves of the hand. ConclusionSurgical resection is a safe procedure for peripheral nerve schwannoma treatment with satisfying functional results and an acceptable risk of nerve injury, especially for sensory function. Level of proofD; Multicenter retrospective study.

Solitary Retroperitoneal Neurofibroma Associated With Deep Vein Thrombosis in a 40-Year-Old Male

A neurofibroma is a benign, non-encapsulated neoplasm of the peripheral nerve sheath. These tumors are a notorious manifestation of the autosomal dominant condition known as neurofibromatosis type 1, where they present as multiple, cutaneous masses with high malignant potential. On the contrary, benign solitary retroperitoneal neurofibromas (SRN) occur without any associated conditions and have rarely been documented. Our case is of a 40-year-old male who presented with a three-month history of painful calf swelling, refractory to over-the-counter painkillers which was later diagnosed as deep vein thrombosis (DVT). A computed tomography (CT) angiogram was done which revealed a mass in the retroperitoneum impinging on the inferior vena cava (IVC). Approximately one month later, the whole mass was surgically excised and histopathology confirmed the diagnosis of a neurofibroma. This case presentation proved to be novel as it highlights the evaluation and management of a rare SRN which resulted in extensive DVT.

Bulboma: A Benign Keratosis With Differentiation Toward the Lower Segment of the Hair Follicle.

:Bulboma is an appellation proposed to designate a distinctive solitary keratosis exhibiting differentiation toward the bulb of the lower segment of the hair follicle. Bulboma is composed of a papillated proliferation of epithelial cells beneath which is a broad front of interconnected follicular papillae. Overlying these coalescing follicular papillae are follicular germinative cells ascending into matrical cells and supramatrical cells. Cells demonstrating differentiation toward Huxley's and Henle's layer of the inner root sheath at the level of the bulb are present including strikingly bright eosinophilic trichohyalin granules and the blue-grey corneocytes of the stem. There is overlying hypergranulosis and orthokeratosis. The clinical and histopathological findings in 4 cases of bulboma, a rare, benign solitary keratosis are presented.

BENIGN SOLITARY FIBROUS TUMUOR OF RETROPERITONEUM – A CASE REPORT.

Solitary brous tumuor (SFT) are rare variety of mesenchymal tumours. Most common location of SFT is pleura. 30% to 40% of SFTs occurs in extra-pleural regions (1). Retroperitoneal SFTs are very rare tumours with around 9 cases reported worldwide (2-7). It can be benign or malignant depending on cellularity, mitotic activity, necrosis and ki-67%. More than 4/mitosis per HPF is considered malignant (8). A 34-year-old lady presented with mass in right side of abdomen measuring 20x10cm, hard in consistency, mobile, no movement with respiration and crossing the midline. Ultrasound abdomen showed 20x11.5cm mass in retroperitoneum with compression of right kidney pelvis causing hydronephrosis. CECT abdomen showed 19.5x16.3x13.6cm mass in the retroperitoneum closely abutting right renal pelvis, adjacent pancreas, duodenum, inferior vena cava, psoas muscle posteriorly and abdominal wall anteriorly. After multidisciplinary tumour discussion surgery was planned for the patient. Patient underwent laparotomy with excision of retroperitoneal mass and right nephrectomy as the mass was densely adherent to right kidney. On histopathological examination of tumour spindle cells arranged in loose fascicles, thinned out wavy nuclei, eosinophilic cytoplasm with less than 3mitosis/ HPF was seen. On immunohistochemistry (IHC) tumour was diffusely positive for CD34 and STAT 6. Tumour was negative for SMA, Desmin, S-100, MUC4 and Beta-catenin. Ki-67% was 0-1%. Thus, a diagnosis of benign solitary brous tumour of retroperitoneum was made

A Case of Schwannoma in Subfrontal Area and Nasal Cavity

Schwannoma is a benign solitary neoplasm emerging from the Schwann cells of the peripheral, cranial and autonomic nerves. Approximately 25 to 45% of schwannomas occur in the head and neck region. However, schwannoma in the subfrontal area, nasal cavity or paranasal sinus is very rare and accounts for only 4% of these neoplasms. We experienced a case of schwannoma in the subfrontal area and left nasal cavity in a 74-year-old man who complained of recurrent rhinorrhea. We report this unusual case of schwannoma with a review of the literature.

PET/CT and contrast-enhanced CT imaging findings in benign solitary schwannomas

ObjectivesImaging features of positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT and pathological changes in benign solitary schwannoma were retrospectively analyzed, and the factors associated with high uptake of fluorodeoxyglucose (FDG) were examined. MethodsThe PET/CT, contrast-enhanced CT, and pathological results of 58 cases of benign solitary schwannomas confirmed by surgery or biopsy were retrospectively analyzed. The association of each variable with the maximum standardized uptake value (SUVmax) was evaluated. ResultsThe SUVmax of the 58 benign schwannoma cases was 4.1 ± 2.1 (1.5–11.1). When the locations of schwannomas were divided into gastrointestinal system/heart/abdominal and pelvic cavities/thoracic wall (type-1 locations) and other sites (type-2 locations), the schwannoma location was significantly correlated with the SUVmax (r = 0.538, p = 0.000). The SUVmax values were 5.8 ± 2.4 and 3.3 ± 1.5, respectively (p = 0.000). Peritumoral lymphoid cuffs were observed in 7 cases, 4 of which were tumors of gastrointestinal origin, accounting for 80 % of the gastrointestinal schwannomas (4/5). The presence of peritumoral lymphoid cuffs was significantly correlated with the SUVmax (r = 0.456, p = 0.000). The location of the schwannoma was significantly correlated with the presence of peritumoral lymphoid cuffs (r = 0.640, p = 0.000). We found that a peritumoral lymphoid cuff is strongly correlated with the presence of regional lymphadenopathy. Among the 7 cases showing peritumoral lymphoid cuffs, 5 cases had the presence of peritumoral enlarged lymph nodes. The degree of enhancement was significantly correlated with the SUVmax (r = 0.556, p = 0.000). ConclusionsBenign schwannomas originating from the gastrointestinal system/heart/abdominal location and showing the presence of peritumoral lymphoid cuffs or moderate and significant enhancement on contrast-enhanced CT were significantly associated with high FDG uptake. An accurate understanding of the factors associated with high FDG uptake can help reduce the misdiagnosis rate.

Novel Method in Performing PTH Washout for Localizing Parathyroid Adenoma: Case Report & an Institute Experience in Qatar

Introduction: Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia and mostly caused by benign solitary benign adenoma (80 to 85 %). Definite treatment is the surgical removal. The most commonly used diagnostic modalities are Sestamibi scan and neck ultrasound (US) which can be inconclusive in some cases. Parathyroid hormone (PTH) washout obtained with ultrasound guided FNA may be useful to accurately localize the adenoma. In our study we describe a novel method for PTH washout. Methods: First, blood samples are drawn from the patient’s peripheral vein and placed in two yellow top tubes (3 ml of blood in each tube). 1 ml of normal saline (NS) will be add to Tube # 1 (Control tube). The suspected parathyroid lesion aspirate is obtained via US guided FNA. It is washed in 1 ml of NS and added to tube #2 (PTH washout tube). Both tubes are sent to our local laboratory for PTH assay. The ratio of PTH in PTH washout tube to control tube (PTH W/C ratio) is calculated and considered positive if more than 2. Results: Total 16 patients (12 females and 4 males) underwent the PTH washout procedure. All patients had PHPT. Out of 16 patients, 13 had inconclusive Sestamibi scan while 3 patients didn’t have the scan due to pregnancy. PTH W/C ratio was positive in 13 patients (ruled in) and negative (ruled out) in 3 patients. All patients underwent parathyroid surgery. The operative findings and pathology report were consistent with PTH W/C ratio findings. i.e. parathyroid hypercellularity was found in all the 13 patients ruled in by PTH W/C ratio. Post-surgery, biochemical parameters normalized in all. Conclusion: PTH washout is an important tool in localizing parathyroid lesion in PHPT when Sestamibi scan cannot be done or if it is inconclusive. PTH W/C ratio can be performed with our novel method to accurately localize the PTH lesion and improve surgical outcome.

Ultrasound Guided Percutaneous Ethanol Ablation of Benign Thyroid Nodule: A Study From a Tertiary Hospital in Eastern India

Abstract Introduction: Ultrasound guided percutaneous ethanol injection (PEI) of benign thyroid nodule is an easy and effective procedure particularly in cystic and predominantly cystic nodule. Aims: To evaluate efficacy and safety of PEI in managing purely cystic and mixed cystic and solid thyroid nodules. Materials and Methods: Patients of either sex presented with solitary purely cystic benign thyroid nodule, solitary benign mixed with predominantly cystic (>50% of total volume) thyroid nodule, solitary benign mixed with predominantly solid (>50% of total volume) thyroid nodule, solitary solid thyroid nodule were included in this study. Patients who had a nodule BETHESDA 3 and above, pregnancy, patients with critical or terminal illness, patients with other malignancies, multinodular lesions of thyroid, patients with raised T3, T4 and/ or suppressed TSH level were excluded from the study. One hundred sixty patients presenting with thyroid nodule were initially evaluated with thyroid function test and USG. Only those patients with euthyroid solitary thyroid nodules are subjected for fine needle aspiration (FNA). Nodules under BETHESDA 2 are considered for US guided percutaneous ethanol injection (PEI). One hundred twenty-three patients were excluded because of various reasons. Finally ethanol ablation was done in 37 patients. Benign, purely cystic and mixed thyroid nodules were aspirated under ultrasonography guidance. Sterile absolute alcohol (99.99%) (50% of volume aspirated/ maximum 10 ml) was injected and reviewed after 2, 5and 7 months. In case of solid nodule alcohol (50% of nodule volume) was injected. A reduction in volume is calculated at each follow up visit. An adequate response is considered as ≥50 percent reduction in size from baseline after 7 months. If the reduction is <50%, then a second session of absolute ethanol injection is given. Again, patients were similarly followed up after 2, 5 and 7 months. Results: Thirty seven patients underwent PEI. Thirty three patients were considered for final analysis (4 lost to follow up). Response rate of PEI for purely cystic nodule was 100.0% and the overall response rate for mixed nodule was 53.57%. None of the solid nodule responded to PEI even after second session. Among the responder in the mixed nodules, 93.33% responded after first session of PEI. Minor complications like headache occurred in 54.1% patients in the first session. Transient pain at injection site were complained by 86.5% and 37.8% patients in the first and second session respectively. Nausea and vomiting were complained by 18.9% and 16.2% patients in the first and second session respectively. Conclusions: PEI is an effective and safe for purely cystic and mixed thyroid nodules. It is a relatively safe and less invasive procedure from management of benign solitary cystic and mixed thyroid nodules.

Bilateral Orthotopic Lung Transplantation after Resection of Benign Solitary Fibrous Tumor in the Donor Lung

IntroductionSolitary fibrous tumor (SFT) of the pleura is a rare soft tissue tumor of mesenchymal origin. Transplantation of donor lung with SFT has not been reported in the literature. We report the first case of a bilateral orthotopic lung transplantation utilizing donor lung which had SFT in the left lung.Case ReportThe donor was a brain dead 25 year old male who suffered from subarachnoid hemorrhage. He had no other comorbidities. The recipient is a 59 year old male with end stage fibrosing interstitial lung disease consistent with usual interstitial pneumonia (UIP) who was listed for bilateral orthotopic lung transplantation. His other comorbidities included triple vessel coronary artery disease, hypertension and type 2 diabetes mellitus. During the lung harvest, it was noted that the left lung had a circumferential 1 centimeter reddish appearing nodule in the left upper lobe. A stapled wedge resection of this nodule was performed during back table dissection. Pathology showed benign solitary fibrous tumor with 1 centimeter negative margins. The recipient underwent BOLT and 3 vessel coronary artery bypass grafting (CABG) on cardiopulmonary bypass via a thoracosternotomy (Clamshell). Post-operative course was uneventful and the patient was discharged home on post operative day 15. He continues to do well and symptom free at 1 year follow up. He underwent chest computed tomography (CT) scan 6 months and 1 year and there were no lung lesions identified.SummaryBilateral Orthotopic Lung Transplantation can be successfully be performed when utilizing donor lungs with benign tumors like solitary fibrous tumor. Regular follow up with CT scans is a necessary surveillance study to ensure there is no tumor recurrence. Solitary fibrous tumor (SFT) of the pleura is a rare soft tissue tumor of mesenchymal origin. Transplantation of donor lung with SFT has not been reported in the literature. We report the first case of a bilateral orthotopic lung transplantation utilizing donor lung which had SFT in the left lung. The donor was a brain dead 25 year old male who suffered from subarachnoid hemorrhage. He had no other comorbidities. The recipient is a 59 year old male with end stage fibrosing interstitial lung disease consistent with usual interstitial pneumonia (UIP) who was listed for bilateral orthotopic lung transplantation. His other comorbidities included triple vessel coronary artery disease, hypertension and type 2 diabetes mellitus. During the lung harvest, it was noted that the left lung had a circumferential 1 centimeter reddish appearing nodule in the left upper lobe. A stapled wedge resection of this nodule was performed during back table dissection. Pathology showed benign solitary fibrous tumor with 1 centimeter negative margins. The recipient underwent BOLT and 3 vessel coronary artery bypass grafting (CABG) on cardiopulmonary bypass via a thoracosternotomy (Clamshell). Post-operative course was uneventful and the patient was discharged home on post operative day 15. He continues to do well and symptom free at 1 year follow up. He underwent chest computed tomography (CT) scan 6 months and 1 year and there were no lung lesions identified. Bilateral Orthotopic Lung Transplantation can be successfully be performed when utilizing donor lungs with benign tumors like solitary fibrous tumor. Regular follow up with CT scans is a necessary surveillance study to ensure there is no tumor recurrence.

Early Onset Colorectal Adenocarcinoma in a 15-Year-Old with Pathogenic Germline Mutations in APC and MLH1: A Case Report

Polyposis and colorectal cancer in children can have various nonspecific presentations such as abdominal pain, unexplained anemia, and weight loss. Polyps in children in the absence of an underlying genetic polyposis syndrome are most often benign solitary hamartomas; however, adenomas can occur and could signal increased risk for malignancy or an underlying genetic cancer syndrome. Familial adenomatous polyposis (FAP) occurs with mutations in the adenomatous polyposis coli (APC) tumor suppressor gene; whereas Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC) mutations, often involve DNA mismatch repair (MMR) genes, such as MLH1, MSH2, MSH6, or PMS2.

Laparoscopic enucleation and spleen saving distal pancreatectomy for synchronous insulinoma and nesidioblastosis in an adult patient

Introduction: Insulinoma is the most common functional neoplasm of the endocrine pancreas. Patients typically present with features known as Whipple triad. 90% of insulinomas are found to be benign solitary adenomas amenable to surgical resection. Method: We present a case of a lady who had endogenous hyperinsulinism with two DOTATATE avid nodules in the pancreatic body and tail who subsequently underwent laparoscopic enucleation and spleen saving distal pancreatectomy. Results: The patient presented initially with features suggestive of Whipple triad. Further workup by the endocrinologist showed results consistent with endogenous hyperinsulinism. Computed Tomography (CT) scan and DOTATATE scan showed that she had one intensely DOTATE-avid exophytic nodule arising from the pancreatic body that is suspicious for a neuroendocrine tumour while the second DOTATATE-avid nodule is close to the pancreatic tail. There is no suspicious nodal or distant DOTATATE-avid metastasis detected. Her case was discussed in the multidisciplinary meeting and the decision was to proceed with laparoscopic enucleation of both lesions. She subsequently underwent laparoscopic enucleation of pancreatic body lesion with spleen saving distal pancreatectomy. She was discharged well on post operative day 3 and remained symptom free during subsequent follow-ups. Final histology came back as grade 1, well differentiated insulinoma of the pancreatic body and incidental pancreatic nesidioblastosis in the pancreatic tail. Conclusion: Laparoscopic enucleation of pancreatic neuroendocrine tumour is feasible and safe method to resect pancreatic neuroendocrine tumour with less morbidity.