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2012, Number 4

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Cir Gen 2012; 34 (4)

Neuroendocrine tumors of the pancreas appearing as ampulomas: report of one case and review of the current diagnostic approach

Andrade-Bucio JA, Andrade-Bucio AF, Hernández-Velázquez EU, Beltrán-Estrada A, Rodríguez-Ortega F, Morales-Padilla A, Jaramillo-Martínez C

Language: Spanish
References: 28
Page: 286-294
PDF size: 225.44 Kb.


ABSTRACT

Objective: To demonstrate a clinical-surgical exercise of the current diagnostic approach for the treatment of a neuroendocrine tumor of the pancreas, with satisfactory results in a selected patient.
Setting: Centro Médico ISSEMYM (Third level health care).
Design: Case report.
Description of the case: A 42-year-old woman with diagnosis of acute pancreatitis, bilirubins indicated an obstructive pattern, retrograde endoscopic cholangiopancreatography was performed that revealed an image suggestive of ulcerated ampuloma; the histopathological report referred: poorly differentiated adenocarcinoma. During evolution, the patient presented cholangitis, which required treatment and a new retrograde endoscopic cholangiopancreatography with esphyncterotomy, choledochus cleaning with balloon, and placement of a plastic French 10 endoprosthesis, with good clinical response. Pancreatoduodenectomy was programmed, finding a pancreatic uncinate process tumor and a tumor in the second portion of the duodenum, the transoperative report corresponded to a neuroendocrine tumor.
Conclusion: Neuroendocrine tumors of the pancreas are rare neoplasms, with a literature reported incidence of less than 1 per 100,000 people per year. They originate from pluripotent cells within the exocrine pancreas and constitute ‹2% of all pancreatic tumors. They are able to produce hormones (insulin, gastrin, VIP, etc.) and their treatment is mainly surgical. Despite being infrequent tumors, neuroendocrine tumors of the pancreas must always be present in the mind of the general surgeon when faced with repeated cholangitis symptoms or as a diagnostic probability of malignant type biliary pathology as suggested by a torpid evolution and supported by imaging studies sensitive to the diagnosis.


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