A Case of Neuroendocrine Tumor of the Pancreas with Hematemesis

Abstract

The patient was a 42-year-old man. He vomited blood and was transported urgently to a nearby hospital in June 2014. Hemostatic treatment with upper gastrointestinal endoscopy (UGE) was conducted. On contrast-enhanced computed tomography (CT), pancreatic tumor, splenomegaly, dilation of the splenic vein, and gastric varices were found. A diagnosis of bleeding from a gastric varix caused by left portal hypertension due to tumor invasion to the splenic vein and tumor embolism was made. He was referred to our hospital for scrutiny and treatment purposes. The tumor showed an unevenly high absorption in the arterial phase and mild low absorption in the venous phase of the contrast-enhanced CT. No increase in pancreatic hormone level was observed by blood biochemical examination. The UGE in our hospital revealed gastric varices and submucosal tumor-like elevation in the posterior wall of the gastric upper body. By endoscopic ultrasonography-guided fine-needle aspiration, a cytological diagnosis of Class V tumor and a histological diagnosis of pancreatic neuroendocrine tumor (PNET) were made. Therefore, distal pancreatectomy, splenectomy, cholecystectomy, total gastrectomy, and partial colon resection were performed. PNETs incidentally found because of hematemesis are extremely rare. The authors report the present case with some considerations of the morphological mechanism that caused the portal hypertension.