Dados do Trabalho

Título

METASTATIC PANCREATIC NEUROENDOCRINE TUMOR: A CASE REPORT ILLUSTRATING THE IMPORTANCE OF MULTIDISCIPLINARY APPROACH

Introdução

PANCREATIC NEUROENDOCRINE TUMORS (PNET) ARE A RARE GROUP OF NEOPLASMS WITH DISTINCT CLINICAL PRESENTATION, WHOSE DIAGNOSIS IS BECOMING INCREASINGLY PREVALENT, ESPECIALLY IN METASTATIC SCENARIOS. CYTOREDUCTIVE SURGERY FOR SYMPTOM MANAGEMENT AND IMPROVEMENT OF SURVIVAL SHOULD BE CONSIDERED IN THOSE CASES, HOWEVER DEFINING THE BEST TREATMENT SEQUENCE IS A CHALLENGING TASK.

Objetivo

WE AIM WITH THE STUDY TO ILLUSTRATE A MULTIDISCIPLINARY APPROACH OF A METASTATIC PNET DESCRIBING ALL TREATMENTS APPLIED AND THE IMMEDIATE ONCOLOGICAL OUTCOMES.

Casuística

CASE REPORT OF A FEMALE PATIENT WITH A METASTATIC PNET.

Método

CASE REPORT OF A FEMALE PATIENT WITH A METASTATIC PNET.

Resultados

IN THIS VIDEOS WE ILLUSTRATE A YOUNG FEMALE WITH INITIAL SYMPTONS OF UPPER ABDOMINAL PAIN, BLOODY DIARRHEA TWICE A DAY, WEIGHT LOSS, FACIAL FLUSHING AND TREMORS.
MAGNETIC RESONANCE (MRI) DEMONSTRATED A SOLID, HYPOVASCULARIZED EXPANSIVE LESION, AFFECTING THE PANCREATIC TAIL MEASURING 67X40MM ASSOCIATED WITH MULTIPLE HYPERVASCULARIZED AND HETEROGENOUS HEPATIC NODULES WITH DIFFUSION RESTRICTION SUSPECTED FOR SECONDARY AFFECTMENT.
TOMOGRAPHY GUIDED BIOPSY OF HEPATIC LESIONS DEMONSTRATED A PNET G2 Ki-67 POSITIVE: 15%. 5-HIAA SERUM LEVEL: 15,2
AFTER DISCUSSION IN TUMOR BOARD, CAPTEM SYSTEMIC TREATMENT WAS PROPOSED, FOLLOWED BY SURGICAL REEVALUATION
TEN CYCLES LATER, SHE WAS SUBMITTED TO A CORPOCAUDAL PANCREATECTOMY + SPLENECTOMY + HEPATIC SEGMENTECTOMIES OF SEGMENTS II, III AND IVA, BILATERAL PELVIC PERITONIECTOMY + BILATERAL ILIAC LYMPHADENECTOMY.
PERFORMED ADJUVANCE WITH SANDOSTATIN AND CONTROL MRI + PET GALIO DID NOT DEMONSTRATE EXTRAHEPATIC DISEASE OR DISEASE PROGRESSION.
THEN SHE WAS SUBMITTED TO RIGHT HEPATOTOMY (FIRST TIME ALPPS) + SEGMENT II RADIOABLATION + CAUDATE SEGMENTECTOMY. AFTER 7 DAYS SHE PERFORMED SECOND TIME OF RIGHT HEPATECTOMY (SECOND TIME ALPPS).
CURRENTLY NO EVIDENCE OF DISEASE AFTER 3 MONTHS

Conclusões

THIS CASE EXEMPLIFIES THE IMPORTANCE OF A MULTIMODAL APPROACH OF METASTATIC PNET IN ORDER TO ACHIEVE EXCELLENT OUTCOMES, WHICH IS FEASIBLE IN REFERENCE HOSPITALS.

Palavras-chave

PANCREATIC NEUROENDOCRINE TUMOR
METASTATIC PANCREATIC NEUROENDOCRINE TUMOR
PNET
METASTATIC PNET