Atypical Pancreatic Carcinoid: One Case Report And Literature Review

Objective: To report one case of atypical pancreatic carcinoid and review the literature about the development in diagnosis and treatment of pancreatic carcinoid in order to direct the clinical diagnosis and treatment in the future. Methods: To retrospectively report and analyze one case of pancreatic carcinoid treated by Qilu Hospital of Shan Dong University in 2005, recorded the clinical manifestations, auxiliary examination, pathological diagnosis, and operation treatment as well as the post-operative prolonged action somatostatin therapy and follow-up at length. Combined with the literature about the diagnosis and treatment of pancreatic carcinoid, we reviewed the development in diagnosis and treatment of pancreatic carcinoid to direct the clinical diagnosis and treatment. Results:State when admitted: The patient was enduring some symptoms of obstructive jaundice such as dark brown urine, light-colored stool, itch of skin, and so on. There was no obvious abnormality in physical examination. Laboratory examinations indicated that level of aminotransferases was high; so did TBIL, primarily constituted by DBIL. Abdominal US and MRI, MRCP indicated that there was an irregular lump at the junction of head of pancreas and duodenum.Process of diagnosis and treatment: After pre-operative examination and making sure no surgical contraindication, we performed pancreaticoduodenoectomy (Whipple's procedure) on the patient under general anesthesia. The post-operative pathological diagnosis was atypical pancreatic carcinoid.The patient was supplied with Sandostatin^? (prolonged action somatostatin), antibiotics, liver-protecting therapy, et al. The patient recovered satisfactorily and didn't recur or metastasize during the follow-up of 17months.According to the literature, pancreatic carcinoid is a rare kind of PEN with low malignant potential, which can easily be misdiagnosed because of its low occurrence, who lack in experiences of diagnosis and treatment, so leading to delay the opportunity of treatment. 34% patients of the pancreatic carcinoid can endure carcinoid syndrome, while the main symptom is pain accompanied by diarrhea and erubescence. Determination of the level of serum 5-HT and immunohistology staining method can be used to diagnose the tumor. US, CT, MRI, SRS and PET can be used to make primary diagnosis. Excision is the first choice for treating pancreatic carcinoid and even can relieve or eliminate symptoms in the cases with metastasis. In drug treatment we can use routine chemotherapy, antihistamine etc. SS and SSA have great therapeutic effect for the patients with irresectable tumor and those with the tumor resected, and can be used as the first-line curative drug to improve situation of the patients, postpone development of tumor and prolong post-operative survival. Conclusions:1) Pancreatic carcinoid is one rare kind of neuroendocrine neoplasm, with low malignant potential, slow growth and low metastasis rate, and can easily be misdiagnosed by the clinical doctors who lack in experience of diagnosis and treatment, so leading to delay the opportunity of treatment because of its low occurrence.2) The determination of surem 5-HT, clinical manifestations such as carcinoid syndrome, imageological examination and pathological diangnosis can help us to diagnose pancreatic carcinoid.3) Excision is the first choice for treating pancreatic carcinoid. SS and SSA can be used as the first-line drug for the patients with irresectable tumor and those with the tumor resected, other drug therapy such as routine chemotherapy and antihistamine drugs can also be used.