title: Case report of multimodality treatment for metastatic parathyroid hormone-related peptide-secreting pancreatic neuroendocrine tumour.
abstract: OBJECTIVE
  Hypercalcaemia due to metastatic parathyroid hormone-related peptide-secreting pancreatic neuroendocrine tumour is challenging to manage and requires a multimodality approach.
  
  
  METHODS
  We present a case of a woman undergoing liver transplantation for metastatic parathyroid hormone-related peptide-secreting pancreatic neuroendocrine tumour.
  
  
  RESULTS
  A young woman with a history of parathyroid hormone-related peptide-secreting pancreatic neuroendocrine tumour (Ki-67 5%) removed in 1998 developed bilobar liver metastases in 2004 and underwent repeated transarterial embolisations of liver tumour and therapy with somatostatin analogue. In view of symptomatic hypercalcaemia refractory to medical therapy, she underwent liver transplantation in 2006. In 2012, follow-up imaging showed a 3-cm hypervascular lesion in the posterior wall of the stomach, which was confirmed on endoscopic ultrasound and on gallium-68-octreotate positron emission tomography scan. A gastric wall resection was performed in February 2013, and biopsies showed a neuroendocrine tumour of intermediate grade (Ki-67 15%). In June 2013, a restaging imaging showed a 2.4 cm lesion in the left breast, which was reported as a primary breast cancer on biopsies, and a 14-mm tissue lesion anterior to the gastric antrum. The patient underwent surgical excision of the breast cancer followed by hormone treatment and radiotherapy. She had surgical removal of the gastric recurrence with adjuvant chemotherapy postoperatively.
  
  
  CONCLUSIONS
  Hypercalcaemia related to parathyroid hormone-related peptide-secreting neuroendocrine tumour can be life-threatening, and liver transplantation may be a viable option in case of liver only diffuse neuroendocrine metastases refractory to other therapies. The risk of tumour recurrence remains a significant clinical problem after liver transplantation, and only a few patients might be considered tumour-free 5 years after liver transplantation.
authors.forename: Roberta Elisa
authors.initials: RE
authors.lastname: Rossi
authors.forename: Keval
authors.initials: K
authors.lastname: Naik
authors.forename: Shaunak
authors.initials: S
authors.lastname: Navalkissoor
authors.forename: Charles
authors.initials: C
authors.lastname: Imber
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: Christos
authors.initials: C
authors.lastname: Toumpanakis
authors.forename: Martyn Evan
authors.initials: ME
authors.lastname: Caplin
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D019394:Ki-67 Antigen / Q000032:analysis; D008113:Liver Neoplasms / Q000378:metabolism / Q000628:therapy; D016031:Liver Transplantation; D018358:Neuroendocrine Tumors / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D044162:Parathyroid Hormone-Related Protein / Q000032:analysis* / Q000378:metabolism; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000628:therapy; D013274:Stomach Neoplasms / Q000556:secondary / Q000628:therapy
chemical_list: D019394:Ki-67 Antigen; D044162:Parathyroid Hormone-Related Protein