Page 79 - Read Online

Fontes-Sousa et al. J Cancer Metastasis Treat 2018;4:5 Journal of Cancer
DOI: 10.20517/2394-4722.2017.70 Metastasis and Treatment

Case Report Open Access

Pancreatic neuroendocrine tumor liver metastasis
in a patient with previously diagnosed pancreatic
adenocarcinoma: an unexpected diagnosis

Mário Fontes-Sousa , Helena Magalhães , Bianca Machado , Olga Sousa , Manuela Machado 1
1
1
3
2
1 Department of Medical Oncology, Portuguese Oncology Institute-Porto, Porto 4200-072, Portugal.
2 Pathology Department, Portuguese Oncology Institute-Porto, Porto 4200-072, Portugal.
3 Radioncology Department, Portuguese Oncology Institute-Porto, Porto 4200-072, Portugal.
Correspondence to: Dr. Mário Fontes-Sousa, Department of Medical Oncology, Portuguese Oncology Institute-Porto, Porto 4200-
072, Portugal. E-mail: mfontes.sousa@ipoporto.min-saude.pt

How to cite this article: Fontes-Sousa M, Magalhães H, Machado B, Sousa O, Machado M. Pancreatic neuroendocrine tumor liver
metastasis in a patient with previously diagnosed pancreatic adenocarcinoma: an unexpected diagnosis. J Cancer Metastasis Treat
2018;4:5. http://dx.doi.org/10.20517/2394-4722.2017.70

Received: 13 Dec 2017 First Decision: 3 Jan 2018 Revised: 4 Jan 2018 Accepted: 8 Jan 2018 Published: 24 Jan 2018
Science Editor: Judy S. Crabtree Copy Editor: Lu Liu Production Editor: Huan-Liang Wu

Abstract
Locally advanced pancreatic carcinoma has an usually poor prognosis despite multimodal approaches and sequential
chemotherapy. The authors present a case of a long-term survivor with stage III pancreatic adenocarcinoma
achieving partial response after a multimodal approach including local and systemic treatments. However, three
years after diagnosis and amidst several episodes of cholangitis, hepatic metastasis were suspected. Despite
pancreatic adenocarcinoma being the obvious culprit for metastization, a hepatic biopsy was considered at that
time given a stable primary disease and presenting three years since the initial diagnosis. At this point, a biopsy
could have specific diagnostic, prognostic and therapeutic implications and after it was performed, an unexpected
diagnosis of pancreatic neuroendocrine tumor was made. Therefore, we urge clinicians to consider hepatic biopsy
in similar cases - generally when it may change prognosis and treatment strategies - and perform histological
confirmation of metastatic disease whenever feasible, even if the answer may seem obvious at first impression.

Keywords: Neoplasm metastasis, pancreatic cancer, neuroendocrine tumors, biomarkers, survivorship, chemoradiotherapy

INTRODUCTION
Pancreatic cancer is becoming increasingly relevant, since it is one of the most lethal cancers, estimated to
[1]
surpass breast cancer deaths by 2017 , which are considerable, and is being contemplated as a public health
[1,2]
issue . At the time of diagnosis, most patients have either locally advanced or metastatic disease, thus not

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.jcmtjournal.com