Ileal neuroendocrine tumor metastasis to pancreas and liver: A case report

Abstract

Introduction: Neuroendocrine tumors (NETs) formally known as carcinoids tumors are neoplasms that arise from enterochromaffin cells. The NETs most commonly occur in the gastro-intestinal tract and predominately within the ileum. Symptomatic ileal NETs have most likely metastasized to the liver at the time of diagnosis. Pancreatic metastasis from ileal NETs are exceptionally rare. Case Report: A 76-year-old female with a primary ileal carcinoid underwent right hemi-colectomy secondary to bowel obstruction. One-year post bowel resection, the patient presented with carcinoid syndrome, imaging revealed a singular hepatic metastasis (segment 2) and a pancreatic tail mass. After radiologic workup with an abdominal CT, PET and octreotide scan a presumed diagnosis of recurrent metastatic NET was made. Multi-disciplinary rounds discussed the case. Laparoscopic distal pancreatectomy, splenectomy and radiofrequency ablation of the liver tumor were performed. Surgical pathology of the pancreatic mass was consistent with primary ileal carcinoid tumor. Conclusion: Ileal NET metastasis to the pancreas is a rare phenomenon. Metastatic NET management should be discussed with a multi-disciplinary team. R0 resection of primary and metastatic NETs offers the only chance of cure. Loco-regional, systemic therapies, and surgical debulking can offer a survival benefit in un-resectable disease or in cases where resection incurs a high perioperative risk.