ECE2014 Poster Presentations Endocrine tumours and neoplasia (99 abstracts)
Pancreatic neuroendocrine tumour with a silent long evolution: case report
Adina Manolachie 1 , Felicia Crumpei 2 , Constantin Volovat 3 , Ioana Bodescu 1 , Jeanina Idriceanu 1 , Ioana Vasiliu 1 , Alina Fadur 1 , Cristina Preda 1 & Carmen Vulpoi 1
1Departament of Endocrinology, University of Medicine and Pharmacy ‘GR. T. Popa’, Iasi, Romania; 2Emergency Hospital ‘Sf. Spiridon’, Iasi, Romania; 3Departament of Medical Oncology, Iasi, Romania.
Pancreatic neuroendocrine tumors (pNET) represent 1.3% of pancreatic tumours, ~65% patients presenting with metastatic/unresectable disease. Clinically, pNET may be asymptomatic, accompanied by carcinoid syndrome or abdominal pain.
Patient N.A. aged 73, with a history of hemorrhagic pancreatitis, was diagnosed in 2003 with a hyperechoic heterogeneous solid pancreatic tumour of 28/28 mm. No therapy/monitoring were proposed. After 7 years of asymptomatic evolution, the patient was hospitalized for diffuse abdominal pain; abdominal CT described a solid tumour in the pancreatic corpus and isthmus and lymphadenopathic block. The tumor size, the adherences and the risk for vital vessels and nerves made the surgical intervention impracticable. Pathological exam (laparoscopic biposy) described a carcinoma metastasis, diffuse positive for cytokeratin AE1/AE3, chromogranin A, synaptophysin and Ki67 positive in 5–6% cells, markers which advocated for a well differentiated neuroendocrine carcinoma. Blood markers confirmed a secretory pNET. Treatment with somatostatin (Sandostatin LAR) was started. For 2 years he had a good evolution without clinical symptoms, with diminution of plasmatic markers (chromogranin A=33.3 ng/ml) and a moderate reduction of tumour size. Sugical intervention was proposed but the patient refused it. Since then (in 12.2011 and 03.2013), he presented two acute episodes, with severe anemia, hypoglicaemia and alteration of general status, with good response to symptomatic treatment.
Conclusions: Incidental discovery of pancreatic tumour, asymptomatic for a long period of time (7 years) resulted in missing best time for surgery, usually the asymptomathic phase for pNET being of 1–2 years. Most pNET present, as our patient, at an advanced stage, the median survival time being 24 months. In spite this, our patient had a longer good evolution. Thus, we may suppose that, treated on time, he might have a better longer disease free period. This case emphasizes the importance early investigations of silent incidentalomas.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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