2020 Volume 53 Issue 10 Pages 784-791
We report a case of intraperitoneal hemorrhage due to rupture of liver metastases from a pancreatic neuroendocrine tumor (pNET) during administration of sunitinib. The patient was a 78-year-old woman who had undergone distal pancreatectomy 8 years ago and was subsequently diagnosed with pNET G2. Two years and 3 months after surgery, multiple liver metastases appeared, and she was treated with everolimus with a total of 10 transcatheter arterial chemoembolizations over 3 years. Since extrahepatic lesions appeared, treatment with sunitinib was initiated. Two months after the treatment started, dynamic CT showed multiple metastatic liver tumors exhibiting low-level enhanced hypovascular change. Sixteen days later, she was transported to emergency with hemorrhagic shock due to rupture of the liver metastatic tumors, and was immediately saved by emergency transcatheter arterial embolization. She was subsequently treated with streptozocin, and dynamic CT showed that the metastatic liver tumors shrunk remarkably at 4 months after the initiation of treatment and the partial response continued for 2 years. She was alive 8 years and 7 months after the first surgery. The possibility of rupture of liver metastases from pNET should be considered when dynamic CT shows that lesions exhibit lowly enhanced hypovascular changes during the administration of sunitinib.
