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Shibata Y, Sudo T, Tazuma S, Onoe T, Yamaguchi A, Shigeta M, Kuraoka K, Yamamoto R, Takahashi S, Tashiro H. Surgical resection of double advanced pancreatic neuroendocrine tumors with multiple renal cell carcinoma associated with von Hippel-Lindau disease. Clin J Gastroenterol 2024; 17:697-704. [PMID: 38693425 DOI: 10.1007/s12328-024-01967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
Von Hippel-Lindau (VHL) disease, an autosomal dominant genetic disorder caused by a germline mutation, is associated with non-functional and slow-growing pancreatic neuroendocrine tumor (PNET) and kidney cancer. We describe the case of a 46 year-old man with a 35 mm mass in the pancreatic head causing stricture of the bile duct and main pancreatic duct, a 55 mm mass in the pancreatic tail causing obstruction of the splenic vein (SV), and multiple masses of > 36 mm on both kidneys. We performed a two-stage resection. First, a total pancreatectomy with superior mesenteric vein (SMV) resection and reconstruction and retroperitoneoscopic right partial nephrectomy (NP) for five lesions was performed, followed by retroperitoneoscopic left partial NP of the five lesions 6 months later. Postoperative histopathological examination revealed NET G2 in the pancreatic head with SMV invasion and somatostatin receptor type 2A (SSTR2A) positivity, NET G2 in the pancreatic tail showed SV invasion and negative SSTR2A, and multiple clear cell renal cell carcinomas (RCC) were also noted. Multiple liver recurrences occurred 22 months after primary surgery. The patient remains alive 41 months after primary surgery. Kidney cancer generally determines VHL prognosis; however, we experienced dual-advanced PNETs with a more defined prognosis than multiple RCC associated with VHL.
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Affiliation(s)
- Yoshiyuki Shibata
- Department of Surgery, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan.
| | - Takeshi Sudo
- Department of Surgery, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Sho Tazuma
- Department of Surgery, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Takashi Onoe
- Department of Surgery, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Atsushi Yamaguchi
- Department of Gastroenterology, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Masanobu Shigeta
- Department of Urology, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Kazuya Kuraoka
- Department of Anatomical Pathology, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Rie Yamamoto
- Department of Anatomical Pathology, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biochemical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hirotaka Tashiro
- Department of Surgery, Chugoku Cancer Center, National Hospital Organization Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, 737-0023, Japan
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Shao Y, Gui Y, Cheng Y, Xu J, Chang X, Lv K. Case report: Peritumoral hepatic steatosis in a patient with a metastatic somatostatin-producing oligosymptomatic neuroendocrine neoplasm. Front Oncol 2022; 12:1013017. [DOI: 10.3389/fonc.2022.1013017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) comprise a heterogeneous collection of tumors derived from various neuroendocrine cells and are divided into functioning NEN and non-functioning NEN. Some NENs present with mild symptoms and can secrete somatostatin. These neoplasms are known as somatostatin-producing oligosymptomatic NENs. In this report, we describe a case of metastatic somatostatin-producing oligosymptomatic NEN with peritumoral hepatic steatosis and review the relevant literature. The patient was a 45-year-old woman who presented with mild steatorrhea and melena. A computed tomography scan revealed an enlarged pancreas protruding into the duodenum. Pathology after total pancreatectomy showed a grade 2 pancreatic NEN with positive somatostatin immunostaining. Enlarging masses on the liver were observed after the operation. Ultrasound examination revealed several lesions in the liver, with inner hypoechoic areas that showed rapid enhancement and fast washout on contrast-enhanced ultrasonography and with outer hyperechoic areas with continuous iso-enhancement. Therefore, the inner hypoechoic areas seen on contrast-enhanced ultrasonography were suspected to be true metastases. A biopsy confirmed this suspicion and indicated that the outer areas were peritumoral liver steatosis. This case highlights the importance of the imaging pattern described in this report for accurate diagnosis of metastatic NEN to avoid incorrect estimation of tumor size or a missed diagnosis on biopsy.
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Vyas M, Zhang X, Morrow JS, Jain D, Salem RR, West AB. Focal hepatic glycogenosis associated with metastatic insulinoma presenting as mass lesions. Pathol Res Pract 2016; 212:59-62. [PMID: 26627264 DOI: 10.1016/j.prp.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/25/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Monika Vyas
- Department of Pathology, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States.
| | - Xuchen Zhang
- Department of Pathology, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States
| | - Jon S Morrow
- Department of Pathology, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States
| | - Dhanpat Jain
- Department of Pathology, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States
| | - Ronald R Salem
- Department of Surgery, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States
| | - A Brian West
- Department of Pathology, Yale University Medical School and Yale New Haven Hospital, New Haven, CT, United States
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