Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone-producing thymic neuroendocrine neoplasm
Journal
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
Journal Volume
33
Journal Issue
3
Date Issued
2021-03
Author(s)
Chen, Kuan-Chih
Sung, Chia-Tung
Chen, Jou-Ho
Abstract
Adrenocorticotropic hormone (ACTH)-producing neuroendocrine neoplasm (NEN) of the thymus is rare. Lymph nodes and bones are the most common metastatic sites. Most cases present with florid Cushing's syndrome (CS). Here, we reported a 58-year-old woman, who presented with intermittent flush and weight loss. Imaging studies revealed tumors in the mediastinum, pancreas, and bones. Contrast-enhanced harmonic endoscopic ultrasound (EUS) of the pancreatic tumors showed heterogeneous and hyperenhancing characteristics. EUS elastography revealed a heterogeneous stiff pattern. EUS-fine needle biopsy to the pancreatic lesion confirmed the NEN nature. Serum ACTH and cortisol levels were abnormally high. Immunohistochemical staining of the thymic and pancreatic specimens was positive for ACTH. However, the patient did not have obvious CS appearance. The patient underwent surgery, radiation, EUS-guided ethanol injection, and anti-cancer medications, but the disease still progressed. The patient died from infection 16 months after NEN was diagnosed. In conclusion, the pancreas can be a metastatic site for ACTH-producing thymic NEN. EUS-associated procedures can help in the diagnosis and treatment of pancreatic metastatic NEN.
Subjects
68Ga-DOTATOC scan; Cushing's syndrome; neuroendocrine neoplasm; pancreas; somatostatin receptor; thymus
SDGs
Other Subjects
CA 125 antigen; CA 19-9 antigen; carcinoembryonic antigen; chromogranin; homeobox protein Nkx 2.1; synaptophysin; corticotropin; adrenocorticotropic hormone producing thymic neuroendocrine tumor; adult; antigen blood level; Article; body weight loss; case
Type
journal article