Acute pancreatitis secondary to non-functioning pancreatic neuroendocrine tumor: uncommon clinical presentation. Clinical case and review of literature

Main Article Content

Alessandro De Cesare
Annalisa Romina Di Filippo
Gianluca Caruso
Martina Spaziani
Roberto Baldelli
Marcello Picchio
Erasmo Spaziani

Abstract

BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are uncommon, representing <5% of all pancreatic neoplasms, divided into functioning PNETs with secreted hormone cause of specific symptoms, and non-functioning PNETs (nfPNETs) characterized by delayed diagnosis with metastases and clinical manifestations of compressive effects. Surgical approach is recommended for functioning and nf-PNETs >2 cm in diameter.


CASE REPORT: A 76-year-old woman was admitted to the UOC-University-Surgery Hospital “A. Fiorini” in Terracina for nausea and pain in the upper abdominal quadrants with dorso-lumbar irradiation, arising after the evening meal.


After the haematochemistry tests and the instrumental investigations, the diagnosis of acute, severe halitiasic pancreatitis was made. Conventional US, CCT, CE-MRI and EUS showed a 2.8cm diameter lesion in the head-body junction of the pancreas. FNA-cytological examination did not found the presence of atypical pancreatic cells. Total-body scintigraphy with Octreoscan® documented a pathological hypercaptation area located in correspondence with the neoformation.


The patient underwent a body-tail spleno-pancreatectomy. The histological examination showed an intermediate grade (G2) nf-PNET infiltrating the lienal vein and stenosing the Wirsung duct, with perilesional pancreatitis.


Immunohistochemistry showed CAM 5.2, Synaptophysin (>95%) and Chromogranin (60%) positive immunophenotype, with negative intratumoral Somatostatin expression.


CONCLUSION: Although rarely, nf-PNETS may be the cause of severe non-biliary acute pancreatitis from pancreatic ductal system compression. In cases where PET/CT68Ga cannot be performed, total-body scintigraphy with Octreoscan® remains the most widely used method for the diagnosis of PNETs and the identification of extra-pancreatic lesions. Chromogranin and Synaptophysin are confirmed as specific markers of neuroendocrine differentiation.


 

 

 

 


 

Article Details

How to Cite
De Cesare, Alessandro, et al. “Acute Pancreatitis Secondary to Non-Functioning Pancreatic Neuroendocrine Tumor: Uncommon Clinical Presentation. Clinical Case and Review of Literature”. Annali Italiani Di Chirurgia, vol. 10, no. January, Jan. 2021, pp. 1-4, https://annaliitalianidichirurgia.it/index.php/aic/article/view/2147.
Section
Case Report
Author Biographies

Alessandro De Cesare, Department of Surgery, “Pietro Valdoni”, Sapienza University of Rome, Italy

 

 

 

Annalisa Romina Di Filippo, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Latina, Italy

 

 

 

Gianluca Caruso, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Latina, Italy

 

 

 

Martina Spaziani, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Latina, Italy

 

 

 

Roberto Baldelli, Department of Oncology and Medical Specialities, AH “San Camillo-Forlanini”, Rome, Italy

 

 

 

Marcello Picchio, Department of Surgery, “P. Colombo” Hospital, Velletri, Rome, Italy

 

 

 

Erasmo Spaziani, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Latina, Italy