Pancreatic Neuroendocrine Tumor Presenting as Acute Pancreatitis

Minjeong Kim; Jin Myung Park; Sung Joon Lee; Chang Don Kang; MyungHo Kang; Ji Hyun Kim; Seungkoo Lee; Seong Whi Cho

doi:10.4166/kjg.2018.71.2.98

Journal List > Korean J Gastroenterol > v.71(2) > 1007775

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Kim, Park, Lee, Kang, Kang, Kim, Lee, and Cho: Pancreatic Neuroendocrine Tumor Presenting as Acute Pancreatitis

Case Report

The Korean Journal of Gastroenterology 2018; 71(2): 98-102.

Published online: 23 February 2018

DOI: https://doi.org/10.4166/kjg.2018.71.2.98

Pancreatic Neuroendocrine Tumor Presenting as Acute Pancreatitis

Minjeong Kim, Jin Myung Park, Sung Joon Lee, Chang Don Kang, MyungHo Kang, Ji Hyun Kim, Seungkoo Lee¹, Seong Whi Cho²

Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

¹Department of Anatomic Pathology, Kangwon National University School of Medicine, Chuncheon, Korea.

²Department of Radiology, Kangwon National University School of Medicine, Chuncheon, Korea.

Correspondence to: Jin Myung Park, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon 24289, Korea. Tel: +82-33-258-9235, Fax: +82-33-258-2455, youreon.park@gmail.com

Received 4 December 2017 Revised 9 January 2018 Accepted 25 January 2018

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Neuroendocrine tumor, Pancreatitis, Endoscopic ultrasound-guided fine needle aspiration

Figures and Tables

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).

Fig. 2

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

Fig. 3

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

Fig. 4

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

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).

Fig. 6

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

Notes

^{Financial support} None.

^{Conflict of interest} None.

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