An Adenoneuroendocrine Collision Tumor of the Pancreas: A Case Report

Case presentation: We present a 57-year-old female with past medical history of lung cancer, COPD, and familial neurofibromatosis who presented with two months of nausea, vomiting, and epigastric abdominal pain. Imaging and endoscopic evaluation revealed extrinsic compression on the third portion of her duodenum. Fine needle aspiration (FNA) biopsies were obtained and were concerning for malignancy. On examination, her blood pressure was 179/84 mmHg, heart rate was 68 bpm, respiratory rate was 18, oxygen saturation was 100%, and temperature was 98.7°F. There were numerous neurofibromas noted mainly on the back and trunk and a few café au lait spots. The abdomen was soft but mildly tender to palpation. The rest of the examination was unremarkable. Initial labs revealed a CO2 of 36 mmol/L (range 22-31 mmol/L), an anion gap of 4 mEq/L (range 8-16 mEq/L), a BUN of 4 mg/dL (range 10-25 mg/dL), a creatinine of 0.60 mg/dL (0.70 – 1.40 mg/dL), a phosphorus level of 2.3 (range 2.6 – 4.9 mg/dL), and an ALT of 41 U/L (range <35 U/L). CA19-9 and CEA were both negative. All other lab values were within normal limits.