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Case Reports
. 2023 Oct 19;12(20):6617.
doi: 10.3390/jcm12206617.

Pancreatic Neuroendocrine Tumor (Pan-NET) Presented by Abdominal Pain: A Case Report and Literature Review

Matteo Regolo  1   2 , Nicolas Cardaci  1   2 , Clara Salmeri  1   2 , Alfredo Laudani  1   2 , Michele Colaci  1   2 , Massimo Ippolito  3 , Fabio Motta  4 , Salvatore Magrì  5 , Stefanie Parisi  5 , Alfredo Gaetano Torcitto  6 , Lorenzo Malatino  1   2
Affiliations
Case Reports

Pancreatic Neuroendocrine Tumor (Pan-NET) Presented by Abdominal Pain: A Case Report and Literature Review

Matteo Regolo et al. J Clin Med. .

Abstract

A pancreatic neuroendocrine tumor (Pan-NET) is a rare neoplasm originating in the neuroendocrine system. Carcinoid syndrome occurs in approximately 19% of patients with functional Pan-NETs, typically when liver metastases occur. In this paper, we describe the case of a patient with a low-grade non-functional Pan-NET, but with a typical clinical presentation of carcinoid syndrome. An 81-year-old male was admitted to our Department of Internal Medicine at Cannizzaro Hospital (Catania, Italy) because of the onset of abdominal pain with nausea, loose stools, and episodic flushing. Firstly, an abdominal contrast-enhanced CT scan showed a small pancreatic hyper-vascular mass; then, a gallium-68 DOTATOC integrated PET/CT revealed an elevated expression of SSTR receptors. Serum chromogranin A and urinary 5-HIAA measurements were negative. We performed an endoscopic ultrasonography (EUS) by a fine-needle biopsy (EUS-FNB), allowing the immunostaining of a small mass (0.8 cm) and the diagnosis of a low-grade (G1) non-functional Pan-NET (NF-Pan-NET). Surgery was waived, while a follow-up strategy was chosen. The early recognition of Pan-NETs, although rare, is necessary to improve the patient's survival. Although helpful to allow for immunostaining, EUS-FNB needs to be warranted in future studies comparing EUS-FNB to EUS-FNA (fine-needle aspiration), which is, to date, reported as the tool of choice to diagnose Pan-NETs.

Keywords: EUS-FNA; EUS-FNB; endoscopic ultrasonography; neuroendocrine tumors (NETs); pancreatic neuroendocrine tumors (Pan-NETs).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Contrast-enhanced abdominal CT scan: axial section showing a homogeneous and hypervascular mass of 8 mm (red arrow) on the arterial phase.
Figure 2
Figure 2
68Ga-DOTA-TOC integrated PET/CT scans, transaxial (A) and MIP (B), show focal and intense uptake in the primary pancreatic lesion (red arrows), with an elevated expression of SSTR2/5 somatostatin receptors.
Figure 3
Figure 3
Endoscopic ultrasound (EUS) image (red arrow) of a small hypo-echogenic lesion with a regular margin and a major axis of 8.9 mm.
Figure 4
Figure 4
(A) Microcores of sample tissue. (B) Abundant blood and entrapped epithelial elements of pancreatic tissue stained with Hematoxylin–Eosin. (C) Epithelial cells, with a granular cytoplasm and nuclei with thickened chromatin (Hematoxylin–Eosin staining). (D) Chromogranin A (5H7 clone, immunohistochemical staining). (E) Synaptophysin (27G12 clone, immunohistochemical staining). (F) Serotonin (YC5/45 clone, immunohistochemical staining). (G) Ki67 (MM1 clone, immunohistochemical staining).
See this image and copyright information in PMC

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