Percutaneous Cryoablation of Recurrent Pancreatic Mass for Life-Threatening Pancreatic VIPoma Syndrome: A Case Report
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CASE REPORT
INTERVENTIONAL ONCOLOGY
Percutaneous Cryoablation of Recurrent Pancreatic Mass for Life-Threatening Pancreatic VIPoma Syndrome: A Case Report Kevin Eng1 • Daniele Wiseman1 • Stan Van Uum2 • Douglas Quan3 Michael Sanatani4 • Amol Mujoomdar1
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Received: 11 May 2020 / Accepted: 14 August 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract We present the case of a 73-year-old female who underwent percutaneous cryoablation for recurrent lifethreatening pancreatic vasoactive intestinal polypeptideproducing tumor (VIPoma) following a pancreaticoduodenectomy and chemotherapy 5 years earlier. She presented with profuse watery diarrhea causing severe electrolyte and acid–base abnormalities, along with acute kidney injury. Cryoablation was successful in treating her profound symptoms, completely reversing her clinical course. The patient has made a successful recovery for the last 1.5 years since the procedure. Keywords Cryoablation VIPoma Ablation
& Amol Mujoomdar [email protected] 1
Division of Interventional Radiology, Department of Medical Imaging, London Health Sciences Centre, Western University, London, ON, Canada
2
Division of Endocrinology, Department of Medicine, St. Joseph’s Health Care, Western University, London, ON, Canada
3
Division of General Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, ON, Canada
4
Division of Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada
Introduction Vasoactive intestinal polypeptide-producing tumors (VIPomas) are rare neuroendocrine tumors with the vast majority arising from the pancreas and are mostly malignant. They secrete vasoactive intestinal polypeptide (VIP), which in the gastrointestinal tract stimulates the secretion of electrolytes and water, leading to profuse secretory diarrhea, hypokalemia, metabolic acidosis, and dehydration, known as VIPoma syndrome. VIP also causes vasodilation which leads to flushing and stimulates bone resorption leading to hypercalcemia [1]. VIPomas are diagnosed by the presence of high-volume secretory diarrhea and an elevated VIP concentration [2]. As most VIPomas express somatostatin receptors, octreotide scans can be useful at localizing the tumor and detecting metastatic lesions [1]. Immediate treatment involves fluid replacement and correction of electrolyte abnormalities. Somatostatin analogues can be given to inhibit VIP secretion to reduce diarrhea. Surgical resection can be done with curative or palliative intention. In patients with VIPoma syndrome, surgery should be attempted if possible due to the syndrome’s life-threatening nature [3]. Other treatment options include radioactive octreotide, cytotoxic chemotherapy, and ablation [1]. We present the case of a 73-year-old female who underwent cryoablation for recurrent lifethreatening pancreatic VIPoma after a pancreaticoduodenectomy and chemotherapy 5 years ea
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