A Case of Double Primary Neuroendocrine Tumor from Duodenum and Pancreas

Dae Won Ma; Min Kyung Kim; Sun Och Yoon; Kwangwon Rhee; Dong-Sup Yoon; Hyojin Park

doi:10.4166/kjg.2013.61.3.155

Journal List > Korean J Gastroenterol > v.61(3) > 1007061

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Ma, Kim, Yoon, Rhee, Yoon, and Park: A Case of Double Primary Neuroendocrine Tumor from Duodenum and Pancreas

Case Report

Korean J Gastroenterol 2013;61(3):155-159.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.3.155

A Case of Double Primary Neuroendocrine Tumor from Duodenum and Pancreas

Dae Won Ma, Min Kyung Kim, Sun Och Yoon¹, Kwangwon Rhee, Dong-Sup Yoon², Hyojin Park

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

¹Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

²Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Hyojin Park, Department of Internal Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: +82-2-2019-3310, Fax: +82-2-3463-3882, E-mail: hjpark21@yuhs.ac

Received 11 May 201211 July 2012 Accepted 12 July 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Neuroendocrine tumors, Pancreas, Duodenum, Multiple endocrine neoplasia type 1

References

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Fig. 1.

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

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).

Fig. 3.

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

Fig. 4.

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

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