Severe gastroenteritis as presentation of a neuroendocrine tumor of pancreas

Abstract

Pancreatic neuroendocrine tumors (PanNETs) are a very rare entity, corresponding to 1-2% of all pancreatic neoplasms, although incidence and prevalence are rising. According to hormonal production, they can be functional or nonfunctional, leading to a subset of symptoms. A 45-year-old man, came to our emergency department complaining of vomiting and profuse non-bloody diarrhea for a week, with asthenia and no improvement with medication. He presented with diminished muscular strength and severe electrolytic changes with electrocardiographic repercussion. Patient was admitted to our intensive care unit (ICU) for hypovolemic and distributive shock due to a severe gastroenteritis. Further research studies were carried out which have shown a nodular structure of 5x4cm in the pancreas tail on computed tomography scan. A biopsy was made, and a histopathological exam revealed a pancreatic well differentiated neuroendocrine tumor. Hormonal analysis showed an elevation on vasoactive intestinal polypeptide (VIP). On 68Ga-DOTA-NOC PET/CT, there were 2 nodular lesions with anomalous overexpression of somatostatin receptors, one in the pancreatic tail near splenic hilum and another in the pancreatic head. Patient underwent a total pancreaticoduodenectomy with en bloc splenectomy. Postoperative period was uneventful. Mostly, this kind of pancreatic neuroendocrine tumors are indolent, but till 39% can have an aggressive course, so they have variable prognosis.