Endocrine Abstracts

Introduction: Despite development of diagnostic and therapeutic possibilities pancreatic neuroendocrine tumours remain still a clinical challenge.

Case report: A 31-year-old woman after cholecystectomy performed in 2007. MRI performed in November 2008 due to abdominal pain revealed tumour of the pancreas – 35×42×32 mm. In May 2009 patient underwent partial excision of the pancreas. On histopathological examination neuroendocrine tumour NET G2 with Ki67 16% was found. Treatment with long acting somatostatin analogue was started. CT performed in October 2009 revealed lesion in the 7th hepatic segment – lesion was verified prior to the surgery as hemangioma. There was no pathological uptake visible in SRS performed in August and then in December 2009. The size of the lesion in the liver was stable on usg performed in February 2010. However USG examination in June 2010 showed additional three lesions in the liver. The progression of the liver changes was confirmed with CT. PET/CT with ⁶⁸Ga-DOTA-TATE revealed increased expression of the somatostatin receptors in the hepatic lesions. Patient did not accede for the surgery and was qualified to the radioisotope therapy. PET/CT performed two months after therapy revealed two additional hepatic changes. Patient was suggested again to undergo surgery. The right-sided hemihepatectomy was performed in October 2011. There was no recurrence nor metastases visible in further imaging examinations till November 2013, when the metastatic lesion in the 1st hepatic segment was revealed by ⁶⁸Ga-DOTA-NOC PET/CT and magnetic resonance imaging. Patient was referred to surgical department.

Conclusions: Above case report shows the necessity of rigorous follow-up of the patients with pancreatic neuroendocrine tumours of intermediate differentiation with uncertain clinical prognosis.