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 Michael Sean Bleszynski1, David F. Schaeffer2, Maja Segedi1 Affiliations: 1Department of General Surgery, University of British Columbia, Vancouver, Canada; 2Department of Pathology, University of British Columbia, Vancouver, Canada. Corresponding Author: Michael Bleszynski, MD, The University of British Columbia Faculty of Medicine, Department of Surgery, Division of General Surgery, Vancouver General Hospital Rm 3100 – Jim Pattison Pavillion North, 950 West 10th Avenue, Vancouver, BC, V5Z 1M9 Canada; E-mail: mbleszyn@gmail.com Received: 27 November 2016 Accepted: 07 February 2017 Published: 07 March 2017 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. Locoregional, systemic therapies, and surgical debulking can offer a survival benefit in unresectable disease or in cases where resection incurs a high perioperative risk.