Pancreatic metastasis from small bowel neuroendocrine tumor

A 60-year-old man, with a past medical history of obesity and diabetes, was admitted for obstructive jaundice. Preoperative CT-scan showed a 3 cm pancreatic head mass causing Wirsung and bile duct dilatation. Endoscopic ultrasonography found a 3 cm pancreatic mass; a biliary stent was placed and a biopsy was performed. Cytology found a moderately differentiated endocrine tumor. 68Ga-DOTATOC PET showed intense fixation of the pancreatic tumor, of multiple lymph nodes on the ileocolic pedicle and of a small tumor localized on the distal ileum (Fig. 1). The hypothesis of a pancreatic neuroendocrine tumor and a small ileal neuroendocrine tumor was considered, and surgery was scheduled. An en bloc right colectomy with mesenteric lymphadenectomy and a pancreaticodudoenectomy were performed with an uneventful postoperative course. Pathology showed a moderately differentiated (KI-67: 7%) ileal tumor with multiple lymph node metastases (16/48) and an intrapancreatic metastasis with angioinvasion (Fig. 2). Fig. 2Ileal neuroendocrine tumor (A, B) with pancreatic metastasis (C, D) Haematossilin and eosin (A, B), Serotonine (C, D) immunohistochemistry x 35. View Large Image Figure Viewer Download Hi-res image