Abstract
BackgroundSimultaneous occurrence of exocrine and neuroendocrine tumors of the pancreas is very infrequent. We report a patient with an endocrine tumor in the pancreatic-duodenal area and extensive exocrine carcinoma involving the whole pancreas.Case presentationA 69-year-old woman was hospitalized in May 2016 for epigastric pain and weight loss. Her past medical history revealed an undefined main pancreatic duct dilation that was subsequently confirmed at CT scan (23 mm) and endoscopic ultrasound. There was no evidence of pancreatic masses, but the cephalic portion of the main pancreatic duct presented hypoechoic nodules. A diagnosis of the main-duct intraductal papillary mucinous neoplasm was made, and the patient underwent total pancreatectomy. Pathological examination showed a collision tumor constituted by a ductal adenocarcinoma involving the whole pancreas and a neuroendocrine tumor located in the duodenal peripancreatic wall and the head of the pancreas. There was one peripancreatic lymph node metastasis from the ductal adenocarcinoma and eight node metastases from the neuroendocrine tumor. These findings suggested a diagnosis of collision of neuroendocrine and ductal adenocarcinomas of the pancreas. The postoperative course was uneventful.ConclusionsThe coexistence of pancreatic endocrine and exocrine tumors is very uncommon. When present, problems in differential diagnosis may arise between mixed exocrine-endocrine carcinoma or the collision of separate tumors.
Highlights
Simultaneous occurrence of exocrine and neuroendocrine tumors of the pancreas is very infrequent
Problems in differential diagnosis may arise between mixed exocrine-endocrine carcinoma or the collision of separate tumors
We report a patient with a collision pancreatic tumor constituted by a pancreatic ductal adenocarcinoma (PDAC) and Neuroendocrine tumor (NET) associated with a jejunal gastrointestinal stromal tumor (GIST)
Summary
We report a new case of adenocarcinoma coexisting with a metastatic NET of the pancreas, misinterpreted as a malignant IPMN. Intraoperative detection of a jejunal GIST occurred. Based on our case and review of the literature, collision pancreatic cancer is a very uncommon tumor composed at least of two different malignant components. Pathogenesis of this rare entity is substantially unclear, and problems in differential diagnosis may arise between mixed exocrine-endocrine carcinoma or the collision of two distinct tumors. Preoperative diagnosis is difficult because of the lack of specific symptoms and radiological features. Radical resection is still the treatment of choice for resectable tumors, but the prognosis appears unpredictable
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