Collision of a pancreatic ductal adenocarcinoma and a pancreatic neuroendocrine tumor associated with multiple endocrine
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CASE REPORT
Collision of a pancreatic ductal adenocarcinoma and a pancreatic neuroendocrine tumor associated with multiple endocrine neoplasm type 1 Akihisa Ohno1 · Nao Fujimori1 · Masami Miki1 · Takamasa Oono1 · Hisato Igarashi1 · Ryota Matsuda2 · Yutaka Koga2 · Yoshinao Oda2 · Takao Ohtsuka3 · Masafumi Nakamura3 · Tetsuhide Ito4,5 · Yoshihiro Ogawa1 Received: 13 June 2020 / Accepted: 1 September 2020 © Japanese Society of Gastroenterology 2020
Abstract A 54-year-old man with pancreatic head tumor had undergone pancreaticoduodenectomy and was diagnosed with pancreatic neuroendocrine tumor (P-NET) associated with sporadic multiple endocrine neoplasm type 1. Five years after the resection, P-NET recurred and liver metastases were observed. He was treated with a somatostatin analog. Eleven years after the resection, computed tomography revealed a new pancreatic hypodense and hypovascular mass adjacent to the P-NET that was diagnosed as pancreatic adenocarcinoma via endoscopic ultrasound-guided fine-needle aspiration. He underwent a total remnant pancreatectomy. Pathological examination showed that the lesion was constituted by a pancreatic ductal adenocarcinoma (PDAC) and a neuroendocrine tumor. Additionally, the invasive ductal carcinoma collided with the neuroendocrine tumor. Both PDAC and P-NET cells were observed in the collision area. We could observe the onset of PDAC during the treatment of P-NET. Moreover, we are the first to report the case of a collision of pancreatic endocrine and exocrine tumors diagnosed preoperatively. Keywords Pancreatic neuroendocrine tumor · Pancreatic cancer · Collision tumor · Combined tumor · Multiple endocrine neoplasia type 1
Introduction Pancreatic exocrine tumor is rarely associated with pancreatic endocrine tumor [1], and the simultaneous occurrence of exocrine and endocrine tumors of the pancreas is extremely rare. According to the World Health Organization (WHO) * Nao Fujimori [email protected]‑u.ac.jp 1
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3‑1‑1 Maidashi Higashi‑ku, Fukuoka City, Fukuoka, Japan
2
Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
3
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
4
Department of Gastroenterology and Hepatology, International University of Health and Welfare Graduate School of Medicine, Fukuoka, Japan
5
Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, Fukuoka, Japan
histological classification [2], mixed neuroendocrine-nonneuroendocrine neoplasms (MiNEN) are defined as carcinoma containing intimately intermixed exocrine and endocrine components, where each component comprises at least one-third of the tumor tissue. Among them, when the lesion is composed of at least two different malignant components without mixed or transitional areas, which indicate multicentric origin, it is defined as a “collision tumor” [2, 3]. The
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