Disseminated Pancreatic Neuroendocrine Neoplasm (NEN) with an Uncommon Localisation in the Central Nervous System. A Case Report.
BACKGROUND
Neuroendocrine neoplasms (NEN) are rare neoplasms that originate from neuroendocrine cells and are characterized by the potential of hormonal activity. Approximately 70% of these tumours are located in the gastrointestinal system (GI), followed by the bronchi, endocrine glands-like C cells of the thyroid (medullary carcinoma), the parasympathetic and sympathetic system (paragangliomas, pheochromocytoma) and other very rare locations. The prevalence of cerebral metastases in neuroendocrine tumours is estimated by various authors to be approximately 1.5-5%. When the primary tumour is located in the pancreas, it is associated with a risk of cerebral metastases lower than 2%.


METHODS
We describe a patient with a disseminated pancreatic NEN that presented with an isolated lesion in the brain. We gathered the important data via medical history,, observation, analysis of medical records, imaging and others diagnostic tests. Despite the fairly rare prevalence of cerebral metastases in NENs, a neurological work-up should be performed. This should include neuroimaging of the brain, preferably with MR, together with the somatostatin receptor scintigraphy (SRS), in each clinically suspicious case. A histopathological examination of the CNS tumour can confirm a dedifferentiation of NEN in the direction of a neuroendocrine carcinoma (NEC - neuroednocrine carcinoma) with a poor prognosis.


CONCLUSIONS
Cerebral metastases are diagnosed in 1.5-5% of patients with a neuroendocrine neoplasm. In each case suggestive of a dissemination into the central nervous system, MRI of the brain should be performed.
Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Department of Neurological Rehabilitation, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Joanna
J
Białkowska
Department of Clinical Oncology, Institute of Oncology, Warsaw, Poland.
Agnieszka
A
Kolasińska-Ćwikła
Department of Neurological Rehabilitation, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Dorota
D
Mroczkowska
Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Department of Neurosurgery, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Mariusz
M
Sowa
Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Department of Neurosurgery, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Łukasz
Ł
Grabarczyk
Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Department of Neurosurgery, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Wojciech
W
Maksymowicz
Department of Clinical Oncology, Institute of Oncology, Warsaw, Poland.
Andrzej
A
Cichocki
Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Department of Radiology, Clinical University Hospital in Olsztyn, Olsztyn, Poland.
Jarosław B
JB
Ćwikła
Neoplasm Metastasis; Neuroendocrine Tumors; Neuroimaging