Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Sep 6;2022(9):rjac391.
doi: 10.1093/jscr/rjac391. eCollection 2022 Sep.

Extended surgical resection for nonfunctioning duodenal neuroendocrine tumor

Giorgio Lucandri  1 , Giulia Fiori  1 , Sara Lucchese  1 , Vito Pende  1 , Massimo Farina  1 , Marco Giordano  2 , Emanuele Santoro  1
Affiliations
Case Reports

Extended surgical resection for nonfunctioning duodenal neuroendocrine tumor

Giorgio Lucandri et al. J Surg Case Rep. .

Abstract

Duodenal neuroendocrine tumors (NETs) account for <3% of all gastrointestinal NET. Most lesions are small-sized and are located in the first or second duodenal part. Tumoral grading, evaluated by Ki67 index, strongly influences patient's outcome. Endoscopic resection is recommended for lesions measuring <2 cm, while pancreaticoduodenectomy should be the treatment of choice for large duodenal NET; Whipple procedure should be preferred in case of duodenal origin and contiguity with gastric antrum. Involvement of surrounding structures, as well as the presence of resectable liver metastases, does not contraindicate surgical resection. Herein we report a case of a 68-year-old male, presenting with an extensive mass of the descending pre-ampullary duodenal part, with involvement of the right colon and the presence of a pericholecystic single liver metastasis. In spite of such advanced disease, surgery on the patient was successful, with an uneventful postoperative outcome.

Keywords: duodenum; gastroenteropancreatic neuroendocrine tumor; neuroendocrine tumors; pancreaticoduodenectomy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) Contrast CT scan: bulky formation with inhomogeneous uptake, arising from upper duodenal-pancreatic angle (arrowheads). (B) MRI: main lesion appears hypointense on fat-suppressed T1-weighted sequences. Evidence for further retromesenteric contrast enhanced tissue (arrowheads). (C) Contrast CT scan: hypodense rounded liver metastasis arising from segment V, measuring 2.5 cm in diameter (arrows). (D) MRI: T1-appearance of subglissonian pericholecystic liver metastasis (arrows).
Figure 2
Figure 2
(A) Laparoscopic appearance of voluminous mass occupying right flank and hypochondrium. (B) Laparoscopic view of round-shaped pericholecystic liver metastasis. (C) Resected specimen includes right colon (C) and Whipple pancreatoduodenectomy (PD). Liver specimen has been examined separately. (D) After duodenal section, evidence for large rounded mass arising from descending pre-ampullary duodenal part (arrows).
Figure 3
Figure 3
(A) Resected specimen: cut surface appears as firm, fleshy and pink to grey in color (arrows). (B) Hematoxylin and eosin staining. Morphological aspect of polygonal cells with oval nuclei, rounded nucleoli and abundant pale cytoplasm. Evidence for alveolar growth pattern (arrows, 20× magnification). (C) High-degree NET (G3) evidence for several mitotic figures (arrows) Mitotic Index: >20 × 2 mm2 (40× magnification). (D) IHC duodenal slide showing diffuse positivity for CK7 (10× magnification). (E) IHC slide showing diffuse positivity for chromogranin A (40× magnification). (F) IHC slide demonstrating a strong staining for Synaptophysin (40× magnification).
See this image and copyright information in PMC

References

    1. Pavel M, Öberg K, Falconi M, Krenning E, Sundin A, Perren A, et al. . Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012;23:124–30. - PubMed
    1. Jensen RT, Rindi G, Arnold R, Lopes JM, Brandi ML, Bechstein WO, et al. . Well-differentiated duodenal tumor/carcinoma (excluding gastrinomas). Neuroendocrinology 2006;84:165–72. - PubMed
    1. Sheikh MR, Osman H, Cheek S, Hunter S, Jeyarajah DR. Duodenal neuroendocrine tumors: location matters! Am Surg 2016;82:386–9. - PubMed
    1. Klimstra DS, Kloppel G, La Rosa S, Rindi G. Classification of neuroendocrine neoplasms of the digestive system. In: WHO Classification of Tumours of the Digestive System, 5th edn. Lyon: IARC, 2019.
    1. Bonds M, Rocha FG. Neuroendocrine tumors of the pancreatobiliary and gastrointestinal tracts. Surg Clin North Am 2020;100:635–48. - PubMed

Publication types