Management Dilemma: Is Enucleation With Lymphadenectomy a Viable Choice for Large Pancreatic Neuroendocrine Tumors (p-NETs)?

Managing pancreatic neuroendocrine tumors (pNETs) has gradually taken a trend toward conservative management owing to its slow-growing and prolonged course. Though clear criteria exist regarding managing small tumors, the direction of a large tumor remains a dilemma. We present a case of a young 26-year-old lactating woman with a large 3.4 cm × 3.2 cm mass in the uncinate process, which is adjacent to the inferior vena cava (IVC) and has flimsy adhesions to the duodenum. She also had an enhancing adjacent lymph node measuring 1.2 cm × 0.7 cm, which showed enhancement with Ga-68 DOTANOC positron emission tomography/computed tomography (PET/CT) and raised serum gastrin levels. The dilemma was between pancreaticoduodenectomy (PD) or enucleation with lymphadenectomy (EL). Finally, EL was conducted. We discussed this case with relevant studies, which we had referred to because large-sized tumors are not usually enucleated.