Differential Diagnosis
- Single most likely diagnosis
- Well-differentiated neuroendocrine tumor (NET) of the pancreas with residual tumor and hepatic metastases: This diagnosis is most likely due to the patient's history of distal pancreatectomy for a well-differentiated NET, the presence of focal uptake within the surgical bed, and the increased uptake of avid hepatic lesions, which are consistent with metastases.
- Other Likely diagnoses
- Recurrent or residual pancreatic NET: The focal uptake within the surgical bed and the increased uptake of hepatic lesions suggest possible residual or recurrent tumor.
- Hepatic metastases from another primary tumor: Although less likely, the hepatic lesions could be metastases from a different primary tumor, and further evaluation would be necessary to determine the origin of the metastases.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Other aggressive pancreatic tumors (e.g., pancreatic adenocarcinoma): Although the patient's history suggests a well-differentiated NET, it is essential to consider other aggressive pancreatic tumors that could have a similar presentation.
- Lymphoma or other hematologic malignancies: The mildly avid bilateral supraclavicular lymph nodes and the bilateral hilar and subcarinal lymph nodes could be indicative of a lymphoma or other hematologic malignancy, which would require prompt evaluation and treatment.
- Rare diagnoses
- Other rare neuroendocrine tumors (e.g., gastrinoma, glucagonoma): Although less common, other rare neuroendocrine tumors could present with similar findings, and further evaluation would be necessary to determine the specific type of tumor.
- Metastases from a rare primary tumor (e.g., medullary thyroid carcinoma): The hepatic lesions could be metastases from a rare primary tumor, and further evaluation would be necessary to determine the origin of the metastases.