Medical Case Reports

Biography

Biography: Sofia

Abstract

Neuroendocrine carcinoma (NEC) of the pancreas is a rare tumor with aggressive progression and poor prognosis. It’s co-existence with adenocarcinoma poses significant clinical problems and has not been addressed in the literature. Herein, we describe a case of a 51 year old male who underwent pancreatoduedonectomy for a pancreatic head tumor 1.5 x 1 x 1.4cm. Histological examination of the specimen revealed a mixed neoplasm: 1) a well differentiated Cytokeratin 7(+), Cytokeratin 20(+), CEA(+) adenocarcinoma, neoplastic blasts of which are extended focally to the submucosa without invading the muscular layer and 2) a low differentiated NEC consisting of solid clusters and pagetoid formations. The neoplastic cells of the former tumor are homogenous without obvious cytoplasm and a high number of mitoses. Immunohistochemical staining showed that the latter tumor was Cytokeratin 7(-), Cytokeratin 20(-), CEA(-), Cytokeratin MNF 116(+), CD56 (+), NSE (+), Synaptophysin (+), Chromogranin (-). Carcinomatous lymph embolus was obvious as well, but all 18 lymph nodes of the specimen were free of neoplastic disease and the surgical margins of the specimen were tumor free. Two months after the operation the patient developed liver metastasis. Ocreoscan revealed a region with moderate scintillation in the left hepatic lobe. FNA cytology of the hepatic lesions revealed low grade carcinoma with neuroendocrine characteristics and the patients received first line chemotherapy treatment with VP and CDDP. After 2 months CT of the abdomen showed progressive disease (PD) and received 2nd line chemotherapy with paclitaxel, ifosfamide, Mesna and CDDP. Three months later due to PD the patient received 3rd line treatment with Folfox and Avastin but he did not responded and after two months received Folfiri and Avastin. Four months later again the patient had PD and received 5th line treatment with CAV. The patient experienced grade four myelotoxicity without evidence of any response to chemotherapy and denied further treatment. He was discharged from the hospital and succumbed to his disease 13 months after the operation. Co-existence of NEC with adenocarcinoma of the pancreas is a very rare entity, may be resistant to various chemotherapeutic regimens and have very poor prognosis.