Pancreatic neuroendocrine tumor liver metastasis in a patient with previously diagnosed pancreatic adenocarcinoma: an unexpected diagnosis

Locally advanced pancreatic carcinoma has an usually poor prognosis despite multimodal approaches and sequential chemotherapy. The authors present a case of a long-term survivor with stage III pancreatic adenocarcinoma achieving partial response after a multimodal approach including local and systemic treatments. However, three years after diagnosis and amidst several episodes of cholangitis, hepatic metastasis were suspected. Despite pancreatic adenocarcinoma being the obvious culprit for metastization, a hepatic biopsy was considered at that time given a stable primary disease and presenting three years since the initial diagnosis. At this point, a biopsy could have specific diagnostic, prognostic and therapeutic implications and after it was performed, an unexpected diagnosis of pancreatic neuroendocrine tumor was made. Therefore, we urge clinicians to consider hepatic biopsy in similar cases generally when it may change prognosis and treatment strategies and perform histological confirmation of metastatic disease whenever feasible, even if the answer may seem obvious at first impression.