Regolo Matteo, Cardaci Nicolas, Salmeri Clara, Laudani Alfredo, Colaci Michele, Ippolito Massimo, Motta Fabio, Magrì Salvatore, Parisi Stefanie, Torcitto Alfredo Gaetano, Malatino Lorenzo
Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy.
Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy.
J Clin Med. 2023 Oct 19;12(20):6617. doi: 10.3390/jcm12206617.
A pancreatic neuroendocrine tumor (Pan-NET) is a rare neoplasm originating in the neuroendocrine system. Carcinoid syndrome occurs in approximately 19% of patients with functional Pan-NETs, typically when liver metastases occur. In this paper, we describe the case of a patient with a low-grade non-functional Pan-NET, but with a typical clinical presentation of carcinoid syndrome. An 81-year-old male was admitted to our Department of Internal Medicine at Cannizzaro Hospital (Catania, Italy) because of the onset of abdominal pain with nausea, loose stools, and episodic flushing. Firstly, an abdominal contrast-enhanced CT scan showed a small pancreatic hyper-vascular mass; then, a gallium-68 DOTATOC integrated PET/CT revealed an elevated expression of SSTR receptors. Serum chromogranin A and urinary 5-HIAA measurements were negative. We performed an endoscopic ultrasonography (EUS) by a fine-needle biopsy (EUS-FNB), allowing the immunostaining of a small mass (0.8 cm) and the diagnosis of a low-grade (G1) non-functional Pan-NET (NF-Pan-NET). Surgery was waived, while a follow-up strategy was chosen. The early recognition of Pan-NETs, although rare, is necessary to improve the patient's survival. Although helpful to allow for immunostaining, EUS-FNB needs to be warranted in future studies comparing EUS-FNB to EUS-FNA (fine-needle aspiration), which is, to date, reported as the tool of choice to diagnose Pan-NETs.
胰腺神经内分泌肿瘤（Pan-NET）是一种起源于神经内分泌系统的罕见肿瘤。类癌综合征约发生在19%的功能性Pan-NET患者中，通常在发生肝转移时出现。在本文中，我们描述了一例低级别无功能性Pan-NET患者，但具有典型的类癌综合征临床表现。一名81岁男性因出现腹痛伴恶心、腹泻和间歇性潮红入住我们位于意大利卡塔尼亚的坎尼扎罗医院内科。首先，腹部增强CT扫描显示胰腺有一个小的高血运肿块；然后，镓-68 DOTATOC一体化PET/CT显示生长抑素受体（SSTR）表达升高。血清嗜铬粒蛋白A和尿5-羟吲哚乙酸（5-HIAA）检测均为阴性。我们通过细针穿刺活检（EUS-FNB）进行了内镜超声检查（EUS），对一个小肿块（0.8 cm）进行了免疫染色，并诊断为低级别（G1）无功能性Pan-NET（NF-Pan-NET）。放弃了手术，选择了随访策略。尽管Pan-NETs罕见，但早期识别对于提高患者生存率是必要的。虽然EUS-FNB有助于进行免疫染色，但在未来将EUS-FNB与EUS-FNA（细针抽吸）进行比较的研究中，需要对EUS-FNB进行验证，迄今为止，EUS-FNA被报道为诊断Pan-NETs的首选工具。
