Case Report

Unusual Presentation of a Metastatic Pancreatic Neuroendocrine Tumor With Sustained Fever and Weight Loss: A Case Report

Abstract

Pancreatic Neuroendocrine Tumors (NETs) are a group of tumors that are rare with guiding features on CT scans and MRI images. We report a 38-year-old man referring to our hospital with a history of approximately 20 kg weight loss, fever, and night sweating since 2 months ago. He did not mention any other significant complaint except for generalized pain. Lab data revealed mild anemia and an elevated level of lactate dehydrogenase and alanine aminotransferase. Abdominopelvic sonography showed multiple hypoechoic lesions in the liver in favor of metastasis. Upper gastrointestinal endoscopy and colonoscopy were normal. Abdominopelvic CT scan revealed multiple faint arterial hyperenhancing lesions with welldefined borders in all liver segments suggestive of hypervascular metastasis. Suspicious mass lesion near the posterior border of the pancreatic tail was also seen, suggestive of a pancreatic neuroendocrine tumor as the primary source of hypervascular metastatic lesions. The pathology and immunohistochemistry of the liver mass confirmed the diagnosis of NET. After staging evaluation, he was referred to an oncologist for chemotherapy.

[1] Kasumova GG, Tabatabaie O, Eskander MF, Tadikonda A, Ng SC, Tseng JF. National rise of primary pancreatic carcinoid tumors: Comparison to functional and nonfunctional pancreatic neuroendocrine
tumors. J Am Coll Surg. 2017; 224(6):1057. [DOI:10.1016/j.jamcolll- surg.2016.11.014] [PMID] [PMCID]
[2] Hallet J, Law CH, Cukier M, Saskin R, Liu N, Singh S. Exploring the rising incidence of neuroendocrine tumors: A population‐based analysis of epidemiology, metastatic presentation, and outcomes. Cancer. 2015; 121(4):589-97.[DOI:10.1002/cncr.29099] [PMID]
[3] Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncology. 2017; 3(10):1335-42. [DOI:10.1001/jamaoncol.2017.0589] [PMID] [PMCID]
[4] Chu QD, Hill HC, Douglass HO, Driscoll D, Smith JL, Nava HR, et al. Predictive factors associated with long-term survival in patients with neuroendocrine tumors of the pancreas. Annals of Surgical Oncology. 2002; 9(9):855-62. [DOI:10.1007/BF02557521] [PMID]
[5] Strosberg J, Gardner N, Kvols L. Survival and prognostic factor analysis in patients with metastatic pancreatic endocrine carcinomas. Pancreas. 2009; 38(3):255-8. [DOI:10.1097/ MPA.0b013e3181917e4e] [PMID]
[6] Khashab MA, Yong E, Lennon AM, Shin EJ, Amateau S, Hruban RH, et al. EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointestinal Endoscopy. 2011; 73(4):691-6. [DOI:10.1016/j. gie.2010.08.030] [PMID]
[7] Paulson EK, McDermott VG, Keogan MT, DeLong DM, Frederick MG, Nelson RC. Carcinoid metastases to the liver: Role of triplephase helical CT. Radiology. 1998; 206(1):143-50. [DOI:10.1148/ radiology.206.1.9423664] [PMID]
[8] Lee JM, Yoon JH, Joo I, Woo HS. Recent advances in CT and MR imaging for evaluation of hepatocellular carcinoma. Liver Cancer. 2012; 1(1):22-40. [DOI:10.1159/000339018] [PMID] [PMCID]
[9] Wang LX, Liu K, Lin GW, Jiang T. Primary hepatic neuroendocrine tumors: Comparing CT and MRI features with pathology. Cancer Imaging. 2015; 15(1):13. [DOI:10.1186/s40644-015-0046-0] [PMID] [PMCID]
[10] EC Radu, AI Saizu, RR Grigorescu, AE Croitoru, and C Gheorghe. Metastatic neuroendocrine pancreatic tumor: Case report. Journal of Medicine and Life. 2018; 11(1):57-61. [PMCID] [PMID]
[11] Kellock T, Tuong B, Harris AC, Yoshida E. Diagnostic imaging of primary hepatic neuroendocrine tumors: A case and discussion of the literature. Case Reports in Radiology. 2014; 2014:156491. [DOI:10.1155/2014/156491] [PMID] [PMCID]
[12] Yang K, Cheng YS, Yang JJ, Jiang X, Guo JX. Primary hepatic neuroendocrine tumors: Multi-modal imaging features with pathological correlations. Cancer Imaging. 2017; 17(1):20. [DOI:10.1186/ s40644-017-0120-x] [PMID] [PMCID]
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IssueVol 5 No 3 (2020): Summer QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v5i3.4359
Keywords
Neuroendocrine tumor Metastasis Liver mass
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How to Cite
1.
Abbaszadeh M, Salahshour F, Karimpour Reyhan S, Khajavi Rad N. Unusual Presentation of a Metastatic Pancreatic Neuroendocrine Tumor With Sustained Fever and Weight Loss: A Case Report. CRCP. 2020;5(3):67-71.