Diagnosis And Treatment Of Pancreatic Neuroendocrine Neoplasm

Objective: To investigate the diagnosis and treatment of pancreatic neuroendocrine neoplasm,in order to provide some basis and material for the diagnosis and treatment of this disease.Methods: The clinical data of 42 patients with pancreatic neuroendocrine neoplasm treated in our hospital from January 2017 to October 2022 were retrospectively analyzed.Results: The results included general information,laboratory examination,imaging examination,treatment measures,postoperative conditions,pathological results and follow-up.1.General data: There were 42 patients in total,including 20 males(47.6%)and 22females(52.4%),with an average age of 47.05±15.21 years;There were 20 cases(47.6%)of functional pancreatic neuroendocrine neoplasm,all of them were islet cell neoplasm,and 22 cases(52.4%)of non-functional pancreatic neuroendocrine neoplasm.The main clinical manifestations of 20 patients with F-pNEN were intermittent hypoglycemia,fatigue,sweating,dizziness,disturbance of consciousness,palpitation,etc.9 of 22 patients with NF-pNEN were found by physical examination,and the other main clinical manifestations were non-specific abdominal pain,abdominal distension,diarrhea,etc.2.Laboratory tests: 16 of 20 patients with insulinoma had decreased fasting blood glucose,1 of 22 patients with NF-pNEN had decreased fasting blood glucose,and 7had increased fasting blood glucose.AFP was normal in all patients,CA199 was mildly elevated in two patients,CEA was mildly elevated in one patient,and both CA199 and CEA were significantly elevated in two patients with pancreatic neuroendocrine carcinoma.3.Imaging examination: 32 patients underwent abdominal B ultrasound examination,19 cases(59.4%)were detected;Abdominal CT was performed in 41 patients,and 31patients(75.6%)were detected.Abdominal MRI was performed in 39 patients,35 of them were detected(89.7%).EUS was performed in 4 patients and detected in 4(100%).The neoplasm were located in the body and tail of pancreas in 21 cases(50%),head and neck of pancreas in 18 cases(42.9%),uncinate process of pancreas in 3cases(7.1%).4.Treatment measures: Among the 42 patients,3 patients received chemotherapy alone after liver biopsy,1 patient received ultrasound-guided alcohol ablation of islet cell tumor,and the rest patients received surgery,including 23 patients(60.5%)received laparotomy and 15 patients(39.5%)received laparoscopy.5.Pathological results: All patients underwent pathological examination,including 25cases(59.5%)of G1 grade,11 cases(26.2%)of G2 grade,1 case of paraganglioma(2.4%)with uncertain grade,and 5 cases of neuroendocrine carcinoma(11.9%)without grade.The maximum diameter of tumor was 9cm,the minimum diameter was0.8 cm,the mean size was 2.76± 1.78 cm,the median size was 2.5 cm,the mean diameter of tumor in F-pNEN patients was 1.91± 0.69 cm,the mean diameter of tumor in NF-pNEN patients was 3.61± 2.12 cm,the positive rate of Cg A staining was92.9%,the positive rate of Syn staining was 90.5%.6.Postoperative conditions: The most common postoperative complication of patients was pancreatic leakage.Among 38 patients with surgery,11 patients had pancreatic leakage(28.9%),and other common complications were incision infection,abdominal infection and anastomotic leakage.All the complications recovered smoothly after symptomatic treatment.7.Follow-up: 36 patients were followed up,with a follow-up rate of 85.7% and an average follow-up time of 40±22 months.Of the patients followed up,6 died(16.7%),5 due to complications of p NEC,1 due to cardiovascular disease,and the remaining patients had no evidence of significant tumor recurrence.Conclusions:1.pNEN is a rare tumor,with no significant difference in incidence between men and women.The age of onset is older.F-pNEN often has specific symptoms,the most common being insulinoma,while NF-pNEN has no specific symptoms.2.The diagnosis of p NNE depends on the symptoms and imaging examination of patients.At present,there is no specific tumor marker in clinic.The sensitivity and specificity of common tumor markers CEA,AFP and CA199 are not high in patients with pNEN.Abdominal CT is the first choice for imaging examination,and MRI and endoscopic ultrasonography can be used as supplementary methods.3.At present,surgery is still the only way to cure p NNE,and doctors need to formulate appropriate treatment plan according to the patient’s general condition.4.Low-grade p NNE has a good prognosis but requires close follow-up.