Surgical Resection of Sporadic Pancreatic Neuroendocrine Tumors: A Two-Decade Experience at a Large Volume Cancer Center

Kim, B.; Prakash, L.; Ikoma, Naruhiko; Kim, M.; Tzeng, Ching-Wei; Vauthey, J.N.; Lee, J.; Katz, Matthew H.G.; Maxwell, Jessica

doi:10.1016/j.hpb.2022.05.846

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“…In addition, tumors larger than 2 cm are candidates for surgery; however, tumors between 1–2 cm in low-risk lesions may be considered for surgery rather than surveillance [ 27 ]. In the case of pancreatic NETs, the risk of operation rather than the progression or recurrence should be carefully considered [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, tumors larger than 2 cm are candidates for surgery; however, tumors between 1-2 cm in low-risk lesions may be considered for surgery rather than surveillance [27]. In the case of pancreatic NETs, the risk of operation rather than the progression or recurrence should be carefully considered [28]. Our patient's tumor was 51 mm × 37 mm with advanced vascular invasion and liver metastasis and so consensus was hemipancreatectomy and liver transplantation, but the patient and his family refused.…”

Section: Discussionmentioning

confidence: 99%

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Severe hypercalcemia due to metastatic pancreatic neuroendocrine tumor: a case report

Behdadnia,

Jeddi

2023

J Med Case Reports

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Background Hypercalcemia of malignancy, as a paraneoplastic syndrome, is the most common metabolic disorder that accounts for 30% of malignancies and usually has a poor prognosis. Neuroendocrine tumors are uncommon and arise from neuroendocrine cells throughout the body. Actually, paraneoplastic hypercalcemia in neuroendocrine tumors is unusual and mostly associated with parathyroid hormone-related protein (PTHrP) secretion. Case presentation We report a 51-year-old Iranian man who presented with nausea, vomiting, and significant weight loss for 1 month. Laboratory data revealed calcium of 26 mg/dl, accompanied by low level of PTH. Octreotide scan revealed a large donut-shaped octreotide avid lesion in the epigastric region at the right side of the mid-abdomen, with multiple varying size foci of abnormally increased radiotracer uptake in the epigastric region and both lobes of the liver. Endoscopic ultrasonography demonstrated a large heterogeneous mass lesion with irregular outline and good demarcation in the body of the pancreas with diffuse foci of calcification. Percutaneous biopsy of the liver mass demonstrated a well-differentiated neuroendocrine tumor (low grade) confirmed by immunohistochemistry with strongly positive chromogranin and synaptophysin stain. Hypercalcemia was treated with hydration, few sessions of hemodialysis, calcitonin, and denosumab injection. However, the patient developed symptomatic hypocalcemia. Oncology consultation led to prescription of long-acting octreotide 30 mg monthly and everolimus daily. Conclusion Pancreatic neuroendocrine tumor could lead to malignant hypercalcemia; secretion of PTHrP is the most common cause, and signs and symptoms are usually milder than paraneoplastic syndrome due to hematologic and solid tumor. Generally, survival is better; however, its treatment is challenging, and primary debulking surgery is often required. A team approach to management is important at all points.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%