A case of local recurrent pancreatic neuroendocrine tumor, grade 3, after a laparoscopic distal pancreatectomy, showing the intraductal extension, exposure, and through the papilla of Vater access

Abstract

Case: The patient was a 55-year-old female. A tumor of the pancreatic tail was found during a medical examination, and a laparoscopic distal pancreatectomy was performed at our hospital. Histological examination revealed the diagnosis of a pancreatic neuroendocrine tumor (PanNET) grade 3 (G3) (Ki-67 index: 20-30%). Seven months after the initial surgery, bile duct dilatation and abnormal liver functions〔aspartate aminotransferase (AST): 171U/l, alanine transaminase ALT: 86U/l〕were observed, and upper gastrointestinal endoscopy was performed for further examination, showing a papillary reddish tumor with a white coat protruding from the papilla of Vater. Considering the possibility of local recurrence of PanNET G3, although not typical, the patient underwent a remnant total pancreatectomy. Histologically, immunohistochemical stains were positive for synaptophysin and chromogranin A, and the Ki-67 index was around 30-40%, indicating that this tumor was a recurrence of the PanNET G3. The patient is alive without any recurrence at 24 months after the second surgery.