van Lierop Antoon H, Bisschop Peter H, Boelen Anita, van Eeden Susanne, Engelman Anton F, Nieveen van Dijkum Elisabeth J, Klümpen Heinz-Josef
Department of Internal Medicine, Flevoziekenhuis, Almere 1315RA, The Netherlands.
Department of Endocrinology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105AZ, The Netherlands.
J Surg Case Rep. 2019 Dec 9;2019(12):rjz346. doi: 10.1093/jscr/rjz346. eCollection 2019 Dec.
In this case report, we describe a 40-year-old patient with a large grade 2 pancreatic neuroendocrine tumour (pNET) with spleen metastasis. Albeit radical resection, he developed liver metastasis after 2 years, for which he underwent radio frequency ablation and embolization, and was treated successfully with different subsequent lines of systemic therapy. Eight years after the initial diagnosis, he was admitted for symptomatic and refractory hypercalcaemia, due to calcitriol synthesis by the liver metastasis. After tumour load reduction by hemihepatectomy, there was an initial normalization of hypercalcaemia, until it recurred after 18 months. In this period, the liver metastasis had progressed despite chemo- and immunotherapy. Patient underwent an additional extend hemihepatectomy, from which he recovered well with normalization of calcium levels. This case illustrates the hormonal plasticity of pNETs and shows how prolonged survival can be achieved for metastatic pNET by multimodality approach.
在本病例报告中，我们描述了一名40岁的患者，患有伴有脾脏转移的2级大胰腺神经内分泌肿瘤（pNET）。尽管进行了根治性切除，但他在2年后出现了肝转移，为此他接受了射频消融和栓塞治疗，并成功接受了不同后续方案的全身治疗。初始诊断8年后，他因肝转移灶合成骨化三醇而因症状性和难治性高钙血症入院。在通过半肝切除降低肿瘤负荷后，高钙血症最初恢复正常，但18个月后复发。在此期间，尽管进行了化疗和免疫治疗，肝转移仍有进展。患者接受了额外的扩大半肝切除术，术后恢复良好，钙水平恢复正常。该病例说明了pNET的激素可塑性，并展示了如何通过多模式方法实现转移性pNET的长期生存。
