Pancreatic neoplasm: a unique size and presentation

VIPomas are rare pancreatic endocrine tumors (PETs), detected in 1 in 10 million people per year and usually present as a constellation of well-defined clinical features characterized by watery diarrhea, hypokalemia, and achlorhydria (WDHA). Theses tumors secrete an excess of vasoactive intestinal peptide (VIP) and are typically diagnosed only after they have metastasized liver, lymph nodes and lungs (60% to 80%). The diagnosis is confirmed by identifying hyper secretion of VIP in a setting of the localized pancreatic tumor. Symptomatic pancreatic VIPomas are usually solitary, more than 3 cm in diameter, and occur in the tail of pancreas in 75 percent of patients. We demonstrate a rare glimpse at an unusual small size of VIPoma at its earliest clinical presentation.