Korean J Gastroenterol.  2018 Feb;71(2):98-102. 10.4166/kjg.2018.71.2.98.

Pancreatic Neuroendocrine Tumor Presenting as Acute Pancreatitis

• Kim M
• Park JM
• Lee SJ
• Kang CD
• Kang M
• Kim JH
• Lee S
• Cho SW

• KMID: 2405003
• DOI: http://doi.org/10.4166/kjg.2018.71.2.98

Abstract

We report a case of acute pancreatitis secondary to pancreatic neuroendocrine tumor. A 46-year old man presented with upper abdominal pain. The serum amylase and lipase were elevated. Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a 1.7 cm sized mass at the pancreas body with a dilatation of the upstream pancreatic duct and mild infiltrations of peripancreatic fat. An endoscopic ultrasound-guided fine needle biopsy was performed for the pancreatic mass, but only necrotic tissue was observed on the pathologic examination. A chest and neck CT scan revealed anterior mediastinal, paratracheal, and cervical lymph node enlargement, which were indicative of metastasis. An ultrasound-guided core needle biopsy was performed for the enlarged neck lymph node, and pathologic examination revealed a metastatic poorly differentiated carcinoma. Immunohistochemical analysis showed positive staining for synaptophysin, chromogranin A, and CD 56, indicative of a neuroendocrine carcinoma.

Keyword

Neuroendocrine tumor; Pancreatitis; Endoscopic ultrasound-guided fine needle aspiration

MeSH Terms

Abdominal Pain
Amylases
Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Carcinoma, Neuroendocrine
Cholangiopancreatography, Magnetic Resonance
Chromogranin A
Dilatation
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Lipase
Lymph Nodes
Neck
Neoplasm Metastasis
Neuroendocrine Tumors*
Pancreas
Pancreatic Ducts
Pancreatitis*
Synaptophysin
Thorax
Tomography, X-Ray Computed
Amylases
Chromogranin A
Lipase
Synaptophysin

Figure

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  Fig. 1 (A) Abdominal computed tomography showed a 1.7 cm sized low attenuated lesion at the pancreatic body (white arrow), peripancreatic infiltration (arrowheads), adrenal nodule (black arrow), and (B) p-duct dilation (black arrowhead).

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  Fig. 2 Magnetic resonance cholangiopancreatography showed dilation of the upstream pancreatic duct (white arrow).

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  Fig. 3 Immunohistochemical staining. The tumor cells tested positive for pan-cytokeratin (×200).

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  Fig. 4 Neck computed tomography showed multiple cervical lymphadenopathy (white arrow).

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  Fig. 5 Pathologic findings of the neck lymph node with ultrasoundguided core needle biopsy. The tissue showed a sheet of polygonal, monomorphic cells admixed with blood vessels (H&E, ×100).

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  Fig. 6 Tumor cells showing cytoplasmic staining for chromogranin A (×400).

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