Carcinoid of the uncinate process of the pancreas in a child: An unusual case

Ashish Kumar Chowdhury,Jashim Uddin Ahmed,Mowsumi Chowdhury,Satyam Sarker

doi:10.3329/mediscope.v7i1.47141

Abstract

Carcinoid of the pancreas is rare among children. We treated a debilitating child who complained about post-prandial pain with a mass in upper abdomen, vomiting and weakness for a period of six months. Abdominal examination revealed an immobile, mildly tender, solid mass in the right lumbar region. Ultrasonography of abdomen demonstrated a tumour of head of the pancreas and ultrasonography-guided fine needle aspiration cytology of the mass suggested a malignant small round cell tumour. With Computed Tomogram an enhancing compact big mass was found at the head of the pancreas compressing the duodenum without invasion and metastasis. At exploratory laparotomy, we also detected a well-defined, rounded, big solid mass arising from uncinate process of the pancreas with no metastasis. After the excision of the mass along with a healthy portion of uncinate process, the patient recovered successfully. Histopathology evaluation showed a neoplasm composed of small nests and sheets of a dense cluster of malignant round cells with hyperchromatic nuclei, sometimes forming acini with stromal invasion. Diagnosis was malignant carcinoid of the pancreas, T2 N0 M0. At follow-up of three and a half years, the patient was found symptom-free and there was no evidence of recurrence. Mediscope Vol. 7, No. 1: Jan 2020, Page 58-62

Highlights

Adenocarcinoma is the commonest tumour of the pancreas (90%).[1]
Ultra Sonogram, US guidance FNAC (Fine Needle Aspiration Cytology) and CT interpretation suggested it was a Malignant Small Round Cell Tumour (MSRCT) at head of the pancreas that compressed the duodenum and this probably was the cause of postprandial pain and vomiting
Post-prandial abdominal pain and vomiting is an unusual presentation of carcinoid of the uncinate process of the pancreas and may appear as a diagnostic dilemma for limitations

Summary

Introduction

Adenocarcinoma is the commonest tumour of the pancreas (90%).[1]. Pancreatic carcinoids constitute only 1-2 % of pancreatic neoplasms and 2-3 % of all carcinoids.[2]. To know more about the tumour we performed contrast CT (Computed Tomogram) of abdomen which demonstrated a well-defined 6.7 cm × 6.6 cm × 6.5 cm, rounded, heterogeneously enhancing mass arising in the head of the pancreas with no invasion to the bile and pancreatic ducts. After proper resuscitation and taking informed consent, we performed exploratory laparotomy by right upper transverse abdominal incision and observed a big, well-defined, rounded solid mass arising from the uncinate process of pancreas compressing the duodenum. Histopathology evaluation of the specimen showed a malignant neoplasm composed of small nests and sheets of a dense cluster of round cells with hyperchromatic nuclei sometimes forming acini with stromal invasion (Figure 03).

Discussion

Conclusion