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Case Reports
. 2021 Jan 25:2021:8811155.
doi: 10.1155/2021/8811155. eCollection 2021.

Surgical Strategy Based on Radiological 3D Reconstruction in a Giant Metastatic Neuroendocrine Tumor of the Pancreas: A Case Report of an Interdisciplinary Approach

Gabriel Fridolin Hess  1 , Savas Deniz Soysal  1 , Guillaume Nicolas  2 , Martin Bolli  1 , Christoph Johannes Zech  2 , Alexandar Tzankov  3 , Emanuel Christ  4 , Michael Montemurro  5 , Otto Kollmar  1
Affiliations
Case Reports

Surgical Strategy Based on Radiological 3D Reconstruction in a Giant Metastatic Neuroendocrine Tumor of the Pancreas: A Case Report of an Interdisciplinary Approach

Gabriel Fridolin Hess et al. Case Rep Surg. .

Abstract

Background: Neuroendocrine tumors (NETs) are a rare entity and are most commonly found in the gastroenteropancreatic tract. The clinical outcome depends on the potential resectability, grade, and stage. Here, we report a case of a tumor debulking in a metastatic NET of the pancreas. A 25-year-old woman with stable metastatic NET of the pancreas G2 T4N1M1 (hepatic, extrahepatic) already underwent several therapies. Case Presentation. A 25-year-old woman with stable metastatic NET of the pancreas G2 T4N1M1 (hepatic, extrahepatic) already underwent several pharmaceutical therapies. Due to the young age, the G2 characteristic, and the stable liver disease, the decision for debulking was made. Based on a 3D CT scan, an embolization was successfully performed directly prior to a pylorus-preserving pancreatic head resection, advanced interaortocaval lymph node dissection, and an atypical liver resection within segment VI. Histological workup revealed a stage pT3, G2, pN1 (29/34), pM1c (hepatic and extrahepatic), L1, V0, Pn0 with complete surgical resection of the primary tumor (180 mm). The excision of the liver segment V showed a completely resected metastasis.

Conclusions: In this patient, extensive surgery of a pancreatic NET with the aim of a prolonged progression-free survival was performed. Close cooperation between different disciplines is absolutely mandatory. Modern imaging allowed a precise therapy plan to be worked out.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Tumor spread.
Figure 2
Figure 2
Metastatic liver.
Figure 3
Figure 3
68Ga-DOTATATE PET/CT.
Figure 4
Figure 4
3D reconstruction of the arterial and venous blood supply especially of the tumor mass (brown).
Figure 5
Figure 5
Angiography via a 4F-C2-catheter placed in the arteria mesenterica superior (AMS). Please note the multiple small tumor-feeding irregular and tortuous branches that arise from the AMS. The normal branches for arterial supply of the bowel present as regular, straight vessels (arrow).
Figure 6
Figure 6
Tumor mass.
Figure 7
Figure 7
Tumor mass.
Figure 8
Figure 8
Situs after resection.
Figure 9
Figure 9
Situs after reconstruction.
See this image and copyright information in PMC

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