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Case Reports in Surgery
Volume 2016 (2016), Article ID 3240569, 4 pages
http://dx.doi.org/10.1155/2016/3240569
Case Report

A Rare Case of Mixed Neuroendocrine Tumor and Adenocarcinoma of the Pancreas

1Department of General Surgery, University General Hospital of Heraklion, Heraklion, 71110 Crete, Greece
2Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, 71110 Crete, Greece
3Department of Pathology, University General Hospital of Heraklion, Heraklion, 71110 Crete, Greece

Received 7 February 2016; Revised 19 June 2016; Accepted 3 July 2016

Academic Editor: Neil D. Merrett

Copyright © 2016 Sofia Xenaki et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Neuroendocrine carcinoma (NEC) of pancreas is a rare tumor with aggressive progression and poor prognosis. Its coexistence with adenocarcinoma poses significant clinical problems and has not been addressed in the literature. Methods. We describe a case of a 51-year-old male who underwent pancreatoduodenectomy due to pancreatic head tumor  cm. Histological examination of the specimen revealed a mixed neoplasm: (1) a well differentiated adenocarcinoma, neoplastic blasts of which are extended focally to the submucosa without invading the muscular layer, and (2) a low differentiated NEC consisting of solid clusters and pagetoid formations. All 18 lymph nodes of the specimen were free of neoplastic disease and the surgical margins of the specimen were tumor-free. No adjuvant treatment was administered and two months after the operation the patient developed liver metastasis. FNA cytology of the hepatic lesions revealed low grade carcinoma with neuroendocrine characteristics. Five lines of chemotherapy were administered: VP + CDDP, paclitaxel + ifosfamide + Mesna + CDDP, Folfox + Avastin, Folfiri + Avastin, and CAV. During his treatment he revealed PD and succumbed to his disease 13 months after the operation. Conclusion. Coexistence of NEC with adenocarcinoma of the pancreas is a very rare entity presenting significant challenges regarding its adjuvant treatment and the treatment of distant relapse.