Original article | Volume 33, Article 129, 21 Jun 2019 | 10.11604/pamj.2019.33.129.19375

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!

Faten Limaiem

Corresponding author: Faten Limaiem, University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia

Received: 04 Jun 2019 - Accepted: 18 Jun 2019 - Published: 21 Jun 2019

Domain: Oncology,General surgery

Keywords: Pathology, pancreas, immunohistochemistry, neuroendocrine tumor

©Faten Limaiem et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Faten Limaiem et al. Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!. Pan African Medical Journal. 2019;33:129. [doi: 10.11604/pamj.2019.33.129.19375]

Available online at: https://www.panafrican-med-journal.com/content/article/33/129/full

Home | Volume 33 | Article number 129

Original article

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!

Faten Limaiem1,&

 

1University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia

 

 

&Corresponding author
Faten Limaiem, University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia

 

 

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Cystic pancreatic neuroendocrine tumor accounts for 13-17% of pancreatic neuroendocrine tumors and 9-10% of resected cystic tumors. This unusual variant can make clinical diagnosis particularly challenging. A 28-year-old female patient presented with abdominal pain and dyspepsia. General and physical examination was unremarkable. On computed tomography scan a 7.5×5.4×5.2cm thick-walled cystic lesion was noted in the tail region of the pancreas in the stomach bed (A). On the basis of the above findings, the radiologist reported it as suggestive of solid pseudopapillary neoplasm and advised pathological correlation. No abdominal lymphadenopathy was noted. The patient underwent laparoscopic removal of a pancreatic cyst. Intraoperatively, a large cyst was seen located posterior to the stomach in retroperitoneum and was intimately related to the tail of the pancreas. The cyst could be enucleated. On histopathological examination, the sections from the cyst wall showed collagen-rich fibrous tissue in which were embedded small clusters and nests of round cells (B). The cells were monotonous, small to medium in size with amphophilic cytoplasm with indistinct cell borders. The nucleus showed typical stippled nuclear chromatin and no mitoses were noted (C). There was no capsular invasion. Neuroendocrine nature of these round cells was confirmed by performing immunohistochemistry with synaptophysin and chromogranin A (C). Ki67 stained <3% of the cells. These findings corroborated the benign nature of the disease indicating a very good prognosis. Postoperative recovery of the patient was uneventful.

 

 

Figure 1: (A) computed tomography scan of the abdomen showing 6.5×5.4×5.2cm thick-walled cystic lesion in the tail of pancreas (arrow); (B) the tumor cells were monotonous, small to medium in size with amphophilic cytoplasm with indistinct cell borders. The nucleus showed typical stippled nuclear chromatin and no mitoses were noted (Hematoxylin and esosin,×100); (C)immunohistochemical staining of the tumor cells showing positivity for chromogranin A (Immunohistochemistry, ×100)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original article

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!

Original article

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!

Original article

Cystic neuroendocrine tumor of the pancreas a challenging clinical diagnosis!