Korean J Gastroenterol.  2013 Mar;61(3):155-159. 10.4166/kjg.2013.61.3.155.

A Case of Double Primary Neuroendocrine Tumor from Duodenum and Pancreas

• Ma DW
• Kim MK
• Yoon SO
• Rhee K
• Yoon DS
• Park H

• KMID: 1501638
• DOI: http://doi.org/10.4166/kjg.2013.61.3.155

Abstract

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.

Keyword

Neuroendocrine tumors; Pancreas; Duodenum; Multiple endocrine neoplasia type 1

MeSH Terms

Adult
Antigens, CD56/metabolism
Duodenum/*pathology
Endoscopy, Digestive System
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Male
Neoplasms, Multiple Primary
Neuroendocrine Tumors/*diagnosis/metabolism/surgery
Pancreas/*pathology
Synaptophysin/metabolism
Tomography, X-Ray Computed
Antigens, CD56
Synaptophysin

Figure

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  Fig. 1. Esophagogastrodudenoscopy showed a 5 mm sized polypoid lesion with right angle to base at the duodenal 2nd portion.

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  Fig. 2. (A) There were glandular, gyriform and trabecular growth pattern in the duodenum by H&E (×200). (B) Chromogranin A staining revealed negative finding (×200). (C) Plump and polygonal cytoplasm, salt and pepper nuclei were shown at the pancreas by H&E (×200). (D) Weakly and focally positive findings for chromogranin A were seen (×200).

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  Fig. 3. Abdominopelvic computed tomography revealed a 3.0×2.0 cm sized hypervascular tumor (arrow) in the pancreas head.

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  Fig. 4. Magnetic resonance imaging showed that 4×3 mm contrast defect (arrow) noted in the left inferolateral portion of the pituitary gland.

Reference

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