Evaluation and Management of Neuroendocrine Tumors of the Pancreas

Abstract

Pancreatic neuroendocrine tumors are a diverse group of neoplasms with a generally favorable prognosis. Although they exhibit indolent growth, metastases are seen in roughly 60% of patients. Pancreatic neuroendocrine tumors may produce a wide variety of hormones, which are associated with dramatic symptoms, but the majority are nonfunctional. The diagnosis and treatment of these tumors is a multidisciplinary effort, and management guidelines continue to evolve. This review provides a concise summary of the presentation, diagnosis, surgical management, and systemic treatment of pancreatic neuroendocrine tumors.

Keywords: Neuroendocrine tumor; PNET; Pancreas; Surgery.

Figure 1:

(A) Arterial phase CT showing a well-circumscribed, enhancing PNET (arrow). (B) Arterial phase CT showing an enhancing PNET (arrow) which is directly invading the spleen and peritoneal cavity. (C) ⁶⁸Ga-PET allows the entire body to be imaged in a single study. In this patient, who had previously undergone primary PNET resection, extensive metastases are seen in the liver, paraaortic lymph nodes, and left supraclavicular lymph nodes.

Figure 2:

(A) A large, peripherally enhancing PNET in the tail of the pancreas (arrow), and faintly hyper-and hypoenhancing hepatic metastases are seen on venous phase CT. (B) The postoperative venous phase CT from the same patient following distal pancreatectomy, cholecystectomy and multiple ultrasound-guided, microwave ablations of the liver (arrow heads). (C) Intraoperative appearance of the PNET, within the tail of the pancreas.

Figure 3:

(A) Hypoenhancing pancreatic neck mass shown on contrast enhanced, T1 weighted MRI (arrow). (B) The same mass shows intense uptake on ¹¹¹In-SRS (arrow). (C) The mass was well encapsulated and not near the pancreatic duct, thus enucleation and lymphadenectomy were performed.