Near-complete regression of liver metastatic lesions in a patient with advanced pancreatic gastrinoma in response to somatostatin analogue therapy following cytoreductive surgery Abstract #148

Introduction: Although the majority of pancreatic NETs present with hepatic metastases, surgery with curative intent should be the first consideration. Cytoreductive surgery by resection of primary and secondary deposits may be of value in achieving local or endocrine symptoms control.
Aim(s): We describe here a near complete response to treatment with somatostatin analogues with reduction in vascularity and size of tumor bulk, in a patient who underwent initial surgery for metastatic pancreatic NET following primary resection.
Materials and methods: A 23-year-old woman presented with a 2-year history of watery diarrhoea and three weeks of epigastric pain and vomiting. CT showed a 6 x 5 cm enhancing mass in the head of the pancreas with metastatic disease in both lobes of the liver. Plasma gastrin was at 210pmol/L (ref 0-40 pmol/L) and chromogranin A was at 182pmol/L (ref <60), consistent with gastrinoma. All other plasma gut peptides and urinary 5-HIAA were unremarkable. Endoscopy showed duodenitis and normal stomach. Octreotide scan revealed a large somatostatin receptor positive mass that co-registered with the pancreatic mass on CT. Multiple somatostatin-avid metastases in the liver were also evident. The patient underwent Whipple’s procedure plus segmental resection of two left-sided liver lesions with the initial intention of complete resection by a two-stage surgical approach. A histology was consistent with moderately differentiated neuroendocrine tumor in the pancreatic head with microvascular invasion and <1% proliferation rate.
Conference: 7th Annual ENETS Conference (2010)
Category: Clinical
Presenting Author: Dr Dorota Dworakowska

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