AB179. SOH22ABS219. Metastatic poor differentiated neuroendocrine tumor in pancreas

Background: More than 95 percent of the pancreatic neoplasms arise from the exocrine components. Neoplasms arising from the endocrine pancreas comprise less than 5% of pancreatic cancers. In modern clinical series, however, between 50% and 75% of pancreatic NETs are nonfunctioning. These tumors are characterized by variable but most often indolent biologic behavior.

Case Description: A 73 years old male presented to Emergency Department (ED) in Midland Regional Hospital Portlaoise (MRHP) with painful jaundice, with upper abdominal pain and deranged liver enzymes. Past medical history of diabetics type 2 on Janumet controlled, had a CT Thorax abdomen and pelvis which shows a pancreatic mass, liver lesions and pulmonary nodule. MRCP confirmed pancreatic mass invading the Common bile duct. As his liver function test was continuing to derange and his abdominal pain was progressive. He had an endoscopic retrograde cholangiopancreatography (ERCP) and endoscopy ultrasound (EUS). ERCP and EUS shows stenosis of the upper and middle third of CBD? Cholangiocarcinoma. Brushings taken confirmed C4 tumour. Ametal stent was inserted. Patient was discussed in multidisciplinary meeting (MDT) in a tertial hospital and decision for palliative and palliative chemotherapy was made, advice to contact a chemotherapy unit in midlands.

Conclusions: A liver biopsy was done which shows poor differentiated neuroendocrine tumour. Patient was transferred than to palliative care and discussed with oncology which advice patient not for chemotherapy as he is in very advanced stage and high bilirubin and only for comfort care.

Keywords: Pancreatic mass; painful and painless jaundice; neuroendocrine tumor; computer tomography; endoscopic retrograde cholangiopancreatography (ERCP)