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Endoscopic ultrasound ablation in a patient with multiple metastatic pancreatic tumors from adrenocorticotropic hormone‐producing thymic neuroendocrine neoplasm
Author(s) -
Chang LingKai,
Chen KuanChih,
Cheng MeiFang,
Lin ChiaChi,
Wang HsiuPo,
Sung ChiaTung,
Chen JouHo,
Yen RuohFang,
Hsu ChiaLin,
Shih ShyangRong
Publication year - 2021
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.13752
Subject(s) - medicine , endoscopic ultrasound , adrenocorticotropic hormone , pancreas , pathology , radiology , neuroendocrine tumors , neoplasm , mediastinum , hormone
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.