Endocrine Abstracts

Pancreatic neuroendocrine tumors constitute a disease with steadily increasing prevalence worldwide in part owing to the increased detection of early stage disease. Here we present the case of a 49 year old male patient, who was admitted with clinical, laboratory and CT features of acute pancreatitis. A clear cause for the pancreatitis could not be detected. Excessive alcohol intake was reliably denied, and the patient did not take any drugs. Gallbladder and bile ducts were intact without stones, serum calcium and triglycerides were normal, there was no positive family history, and hepatobiliary infection was excluded. Pancreatitis due to microlithiasis was suspected. Two weeks after the initial admission the patient was discharged with recommendation for cholecystectomy and imaging in 3 months due to three small intrahepatic lesions. In the new CT scan, the lesions had marginally increased in size. Remarkable in the laboratory exams was a mild, persistent hyperlipasemia. Tumor markers (AFP, CA 19-9) were slightly elevated. We performed an MRT-guided biopsy of one hepatic lesion. The histopathological result was negative. Due to the missing cause of pancreatitis, we proceeded to a second biopsy of the lesions, which this time histopathologically confirmed the infiltration by a neuroendocrine carcinoma with high proliferation rate. A systematic chemotherapy with cisplatin and etoposid was initiated. This case underlines that pancreatic neuroendocrine carcinoma, particularly in its early stage, may mimic, despite high malignancy, a pancreatitis with non-specific symptoms, causing delay in the initiation of therapy. Serum tumor markers can be helpful, especially if a clear cause or typical clinical, laboratory or imaging features are missing. The individualized decision for pathological validation with high sensitivity and specificity corroborates the final diagnosis, weighing the potential complications of the procedure against the diagnostic benefits.