{"title":"Successful Conversion Surgery for Locally Advanced Pancreatic Neuroendocrine Carcinoma: A Case Report.","authors":"Yuuko Tohmatsu, Mihoko Yamada, Nobuyuki Ohike, Tomoko Norose, Hidemasa Kubo, Ryo Ashida, Katsuhisa Ohgi, Shimpei Otsuka, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Takashi Sugino, Teiichi Sugiura","doi":"10.70352/scrj.cr.24-0064","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic neuroendocrine carcinoma (panNEC) is a poorly differentiated, highly malignant neoplasm with an extremely poor prognosis. This tumor often presents as locally advanced or unresectable at the initial diagnosis.</p><p><strong>Case presentation: </strong>A 72-year-old woman presented to our hospital with weight loss. A computed tomography scan showed an enhanced tumor measuring 32 mm in the pancreatic head region, with contact to the common hepatic artery over 180°. The pathological findings from the specimens obtained via endoscopic ultrasonography-guided fine-needle aspiration identified small cell-type NEC with extensive necrosis, leading to a diagnosis of locally advanced unresectable panNEC. Accordingly, she began a course of carboplatin and etoposide therapy. After 7 courses, given the significant shrinkage of the tumor, we performed a pancreatoduodenectomy as a conversion surgery. Pathological examination revealed a localized, residual nodule of NEC, consisting mainly of large neoplastic cells, with carcinoma <i>in situ</i> components scattered within and around the nodule. In addition, the diffuse membrane expression of somatostatin receptor 2 was observed in NEC components. Each component showed the same type of <i>KRAS</i> mutation (p.G12V) and was considered to originate from a single primary tumor in the pancreas. She received 3 courses of the same regimen as adjuvant chemotherapy and has remained recurrence-free for 24 months.</p><p><strong>Conclusion: </strong>This is a rare case of successful conversion surgery for locally advanced, unresectable panNEC after chemotherapy, providing several important histopathological and molecular insights.</p>","PeriodicalId":22096,"journal":{"name":"Surgical Case Reports","volume":"11 1","pages":""},"PeriodicalIF":0.7000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933743/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.70352/scrj.cr.24-0064","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/20 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Pancreatic neuroendocrine carcinoma (panNEC) is a poorly differentiated, highly malignant neoplasm with an extremely poor prognosis. This tumor often presents as locally advanced or unresectable at the initial diagnosis.
Case presentation: A 72-year-old woman presented to our hospital with weight loss. A computed tomography scan showed an enhanced tumor measuring 32 mm in the pancreatic head region, with contact to the common hepatic artery over 180°. The pathological findings from the specimens obtained via endoscopic ultrasonography-guided fine-needle aspiration identified small cell-type NEC with extensive necrosis, leading to a diagnosis of locally advanced unresectable panNEC. Accordingly, she began a course of carboplatin and etoposide therapy. After 7 courses, given the significant shrinkage of the tumor, we performed a pancreatoduodenectomy as a conversion surgery. Pathological examination revealed a localized, residual nodule of NEC, consisting mainly of large neoplastic cells, with carcinoma in situ components scattered within and around the nodule. In addition, the diffuse membrane expression of somatostatin receptor 2 was observed in NEC components. Each component showed the same type of KRAS mutation (p.G12V) and was considered to originate from a single primary tumor in the pancreas. She received 3 courses of the same regimen as adjuvant chemotherapy and has remained recurrence-free for 24 months.
Conclusion: This is a rare case of successful conversion surgery for locally advanced, unresectable panNEC after chemotherapy, providing several important histopathological and molecular insights.