Mixed Neuroendocrine and Non-Neuroendocrine Neoplasm of Pancreas: What Do We Know, What Have We Learnt?

Abstract

Pancreatic adeno- Mixed neuroendocrine non-endocrine (pMINEN) are extremely rare. [1] They are known to have distal metastasis at presentation and also have a comparatively lower survival rate as compared to similar staged neuroendocrine carcinoma, adenocarcinoma, and small cell lung tumor from which its treatment patterns are extrapolated. [2,3] Also, very less is known about its molecular structure and natural courses. There is a dearth of data about pMINEN in literature also there is a lack of large multicentral trials due to which the MINEN do not have a standard universal management protocol. We here discuss the clinical dilemmas that arise during diagnosis, reporting, and urge to formulate a multi-centric trial to formulate a focused protocolized approach. We here describe our encounter with a pancreatic head lesion which on immunohistochemically turned out to be a pMINEN with moderately differentiating ductal adenocarcinoma and low-grade neuroendocrine tumor. Radical R0 surgery with multimodal treatment (chemotherapy + radiotherapy) gains improved survival in long term.