Unexpected Long term Survival after Surgical Resection for Non-functioning Pancreatic Neuroendocrine Carcinoma with Cutaneous Metastasis

초록

Introduction: Non-functioning pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors and they account for 2% of all pancreatic malignancy. About 60% of NF-PNETs present distant metastases and usually hepatic metastases. However, cutaneous metastases are very rare. Method: Herein, we reported our experience. Result: . A 60-year-old man visited our outpatient clinic with a mass on his left hip. An abdominal CT scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the body of the pancreas. Initially, we removed the metastatic lesions, which was a small cell neuroendocrine carcinoma with 50% of the Ki-67 index in the histopathological report. After 3 weeks, we performed a total pancreatectomy and a total gasterectomy with findings of an invasion of the left gastric artery, splenic artery, and splenic vein. Four weeks after the 1st operation, we detected a recurrence at the operative bed on his left hip, and removed recurring mass. The patient was received chemotherapy based on etoposide and cisplatin treatment. Malignant ascites was developed at 18.1 months after operation, and the patient passed away at postoperative 19.2 months. Conclusion: Surgical resection for pancreatic neuroendocrine carcinoma is genreally not recommended, because of dismal prognosis. Debulking resection with the removal of 90% of tumor voluem can be prolonged survival outcome, even though there is cutaneous metastasis.