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. 2018:52:1-4.
doi: 10.1016/j.ijscr.2018.09.031. Epub 2018 Sep 23.

Cystic mixed adenoneuroendocrine carcinoma of the pancreas: A case report

Nao Shimada  1 , Shiro Miwa  2 , Takuma Arai  3 , Noriyuki Kitagawa  2 , Shingo Akita  2 , Nobuyoshi Iinuma  2 , Keiko Ishii  4
Affiliations

Cystic mixed adenoneuroendocrine carcinoma of the pancreas: A case report

Nao Shimada et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Pancreatic mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor. We report herein a case of pancreatic MANEC with cystic features.

Presentation of case: A 67-year-old woman presented with jaundice. A CT scan revealed an 18-mm mass at the pancreatic head that obstructed the common bile duct and another 35-mm cystic lesion containing a mural nodule in the pancreatic body, which was suspected to be an intraductal papillary mucinous carcinoma. A biopsy of the head mass led to the diagnosis of adenocarcinoma. The patient underwent pancreatoduodenectomy, and the body cyst was resected with the head mass. A histopathological analysis revealed that the body cyst had two components, ductal adenocarcinoma and neuroendocrine tumor. We diagnosed the cystic tumor as MANEC.

Discussion: Cases of MANEC have been reported as originating from the stomach, small intestine, and colon, but pancreatic MANEC is rare. The histogenesis and the therapeutic strategy for pancreatic MANEC are controversial.

Conclusion: The clinicopathological features of pancreatic MANEC remain unclear; therefore, more reports of cases of pancreatic MANEC are necessary for a complete analysis.

Keywords: Cystic tumor; Mixed adenoneuroendocrine carcinoma; Pancreas.

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Figures

Fig. 1
Fig. 1
Abdominal enhanced CT images, A and C: Early phase. B and D: Delayed phase. A and B: There is an 18-mm solid mass in the pancreatic head. The mass was poorly enhanced in the delayed phase and obstructed the common bile duct and the main pancreatic duct. C and D: A 35-mm cystisin the pancreatic body and is connected to the main pancreatic duct.
Fig. 2
Fig. 2
Ultrasonography of the cyst connected to the main pancreatic duct, which contained a small solid component (arrows).
Fig. 3
Fig. 3
A resected 25-mm cystic mass from the pancreatic body that was continuous with the main pancreatic duct.
Fig. 4
Fig. 4
Low-power view of the MANEC (left) (hematoxylin and eosin stain). A pink line outlines the adenocarcinoma in situ and the blue area contains the NEN (NET G1) (right).
Fig. 5
Fig. 5
High-power view of the two components of the MANEC(hematoxylin and eosin stain). The internal glandular material expresses CEA but not chromogranin Aor synaptophysin. The outer solid tumor islands were negative for CEA but positive for chromogranin A and synaptophysin.
See this image and copyright information in PMC

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