Abstract
A 44-year-old woman who visited a neighboring hospital complaining of diarrhea, itching, and body weight loss of 4 kg during 6 months was referred to our hospital because a tumor of the pancreas head was pointed out by abdominal CT and MRI scanning. Percutaneous transhepatic cholangiodrainage (PTCD) was performed to relieve obstructive jaundice. Cytology diagnosis was made by using endoscopic retrograde cholangiopancreatography (ERCP), and immunostaining revealed a diagnosis of pancreatic neuroendocrine tumor. The tumor diameter was 8.4 cm. Although demonstrable metastasis was absent, tumor emboli were noted in the portal and splenic veins and the hepatic artery appeared to be involved as well. We thus determined the case to be of unresectable and started chemotherapy with everolimus (oral) and somatostatin analog (intramuscular). Seven months later the tumor diameter decreased to 5 cm. The tumor embolus in the portal vein was still left, but the hepatic artery and the tumor were detached each other. We decided the tumor to be resectable and scheduled surgery. Radical operation was done by pancreaticoduodenectomy, associated resection of the portal vein (5 cm) and reconstruction of the portal vein by using right external iliac vein. Since there are few cases of pancreatic neuroendocrine tumor treated by neoadjuvant chemotherapy followed by radical operation, we present our case with a review of the literature.
