Abstract
Pancreatic neuroendocrine microadenomas (NEMAs) are non-functioning neuroendocrine tumors < 0.5 cm with a low proliferation rate and are considered benign. We report on a pancreatic NEMA with lymph node metastasis. A male in his 70s had pylorus-preserving pancreaticoduodenectomy for a distal bile duct carcinoma, which was a 2.1 cm well-differentiated-infiltrating adenocarcinoma with invasion limited to the bile duct wall. An incidental separate 0.4 cm well-differentiated NEMA was found in the pancreatic head with metastatic well-differentiated neuroendocrine tumor in one peripancreatic lymph node. Both neuroendocrine tumors in the pancreatic head and in the lymph node were composed of nests of uniform neoplastic cells with a fine chromatin pattern. The Ki-67 labeling index of NEMA was 0.85%. The neoplastic neuroendocrine cells in both the pancreas and node were diffusely positive for synaptophysin, chromogranin, and insulin. Therefore, this unusual case provides an exception to the current classification system which regards NEMAs as benign lesions.
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Funding
The study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B4009381), a grant (2013–554) from the Asan Institute for Life Sciences, Seoul, Republic of Korea (SMH), the 2016 Basic/Translational Science Investigator Award from the North American Neuroendocrine Tumor Society supported by the Neuroendocrine Tumor Research Foundation (CMH), and NIH grant CA62924 (RHH).
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Jeong-Hwa Kwon: study design, tissue sampling, drafting of the manuscript
Hyoung Jung Kim: analysis of clinical features
Do Hyun Park: tissue sampling, analysis of clinical features
Young-Joo Lee: tissue sampling, analysis of clinical features
Christopher M. Heaphy: histological analysis, drafting of the manuscript
Günter Klöppel: histological analysis, interpretation of data
Ralph H. Hruban: histological analysis, interpretation of data, drafting of the manuscript
Seung-Mo Hong: study design, histological analysis, interpretation of data, drafting of the manuscript, study supervision
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The authors declare that they have no conflict of interest.
Additional information
This study has been presented, in part, at the 14th Annual ENETS Conference, Barcelona, Spain, March 8–10, 2017.
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Kwon, JH., Kim, H.J., Park, D.H. et al. Incidentally detected pancreatic neuroendocrine microadenoma with lymph node metastasis. Virchows Arch 473, 649–653 (2018). https://doi.org/10.1007/s00428-018-2407-0
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DOI: https://doi.org/10.1007/s00428-018-2407-0