Wahab Ahsan, Raman Puneet, Koshy Matthew, Chen Yolande
Department of Hematology Oncology, University of Illinois, Chicago, IL, USA.
Department of Radiation Oncology, University of Illinois, Chicago, IL, USA.
Am J Case Rep. 2025 Sep 6;26:e949041. doi: 10.12659/AJCR.949041.
BACKGROUND Treatment of metastatic vasoactive intestinal peptide tumors (VIPoma) is challenging and requires a careful multidisciplinary approach to achieve optimal disease control. We present a case of metastatic VIPoma with recurring episodes of life-threatening diarrhea necessitating multiple intensive care unit (ICU) admissions. CASE REPORT A 54-year-old man presented with severe watery diarrhea and metabolic acidosis with MRI showing a necrotic pancreatic body mass, and multiple liver lesions. Histopathologic and biochemical findings were consistent with VIPoma. Due to the multifocal liver lesions, he was deemed unsuitable for curative surgical intervention, shifting focus to other therapies. Initial treatments over 7 months included octreotide, transarterial chemoembolization, yttrium-90 radioembolization, and systemic therapy with everolimus, with decreases in serum vasoactive intestinal peptide (VIP) levels from a peak of 3180 pg/mL to undetectable levels corresponding to temporary relief of diarrhea. However, the temporary relief was followed by a rapid increase in VIP levels into the 200s and 300s and recurrence of 3-11 liters of diarrhea per day. He had multiple ICU admissions due to severe diarrhea/hypovolemic shock until he was treated with stereotactic body radiation therapy (SBRT). SBRT of the pancreatic site immediately yielded long-term hemodynamic stability, prevented further ICU admissions, and enabled the patient to receive debulking surgery. CONCLUSIONS Although radiation is not typically a primary treatment modality for VIPoma, in this case, the high dose per fraction delivered with stereotactic technique to a pancreatic mass played a crucial role in alleviating his catastrophic volume loss through intravenous octreotide-refractory diarrhea, making the patient a suitable candidate for debulking surgery. This case highlights the importance of considering all available treatment options, even those not traditionally employed, when managing complex cases with refractory symptoms.
背景 转移性血管活性肠肽瘤（VIPoma）的治疗具有挑战性，需要谨慎的多学科方法以实现最佳的疾病控制。我们报告一例转移性VIPoma患者，其反复出现危及生命的腹泻发作，需要多次入住重症监护病房（ICU）。病例报告 一名54岁男性出现严重水样腹泻和代谢性酸中毒，MRI显示胰腺体部有坏死性肿块以及多个肝脏病变。组织病理学和生化检查结果与VIPoma相符。由于肝脏病变为多灶性，他被认为不适合进行根治性手术干预，治疗重点转向其他疗法。在7个月的初始治疗中，包括使用奥曲肽、经动脉化疗栓塞、钇-90放射性栓塞以及依维莫司全身治疗，血清血管活性肠肽（VIP）水平从峰值3180 pg/mL降至无法检测的水平，腹泻暂时缓解。然而，短暂缓解之后，VIP水平迅速升至200多和300多，再次出现每天腹泻3至11升的情况。由于严重腹泻/低血容量性休克，他多次入住ICU，直到接受立体定向体部放射治疗（SBRT）。胰腺部位的SBRT立即带来了长期的血流动力学稳定，避免了进一步入住ICU，并使患者能够接受减瘤手术。结论 尽管放射治疗通常不是VIPoma的主要治疗方式，但在本病例中，立体定向技术对胰腺肿块给予的高剂量分次照射在缓解其因静脉注射奥曲肽难治性腹泻导致的灾难性容量丢失方面发挥了关键作用，使患者成为减瘤手术的合适候选者。该病例突出了在处理具有难治性症状的复杂病例时，考虑所有可用治疗选项（即使是那些传统上未采用的选项）的重要性。
