Incidental neuroendocrine tumor discovered after total pancreatectomy intended for islet autotransplantation: Important considerations for surgical decision-making

Oscar K. Serrano, Kent J. Peterson, Tetyana N Mettler, Joshua J. Wilhelm, Melena D Bellin, Gregory J Beilman, Guru V Trikudanathan, Timothy L Pruett, Ty B Dunn

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.

Original languageEnglish (US)
Pages (from-to)778-782
Number of pages5
JournalPancreas
Volume47
Issue number6
DOIs
StatePublished - Jul 1 2018

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Pancreatectomy
Neuroendocrine Tumors
Autologous Transplantation
Decision Making
Chronic Pancreatitis
Neoplasms
Transplantation
Biopsy

Keywords

  • Key Words/Abbreviations
  • chronic pancreatitis
  • glucagonoma
  • pancreatic neuroendocrine tumor
  • total pancreatectomy with islet autotransplantation

PubMed: MeSH publication types

  • Case Reports
  • Journal Article

Cite this

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title = "Incidental neuroendocrine tumor discovered after total pancreatectomy intended for islet autotransplantation: Important considerations for surgical decision-making",
abstract = "Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.",
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T1 - Incidental neuroendocrine tumor discovered after total pancreatectomy intended for islet autotransplantation

T2 - Important considerations for surgical decision-making

AU - Serrano, Oscar K.

AU - Peterson, Kent J.

AU - Mettler, Tetyana N

AU - Wilhelm, Joshua J.

AU - Bellin, Melena D

AU - Beilman, Gregory J

AU - Trikudanathan, Guru V

AU - Pruett, Timothy L

AU - Dunn, Ty B

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.

AB - Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.

KW - Key Words/Abbreviations

KW - chronic pancreatitis

KW - glucagonoma

KW - pancreatic neuroendocrine tumor

KW - total pancreatectomy with islet autotransplantation

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