A giant non-functioning pancreatic neuroendocrine carcinoma founded as an incidentaloma successfully treated with pancreatoduodenectomy

Pancreatic neuroendocrine tumours (PTENs) are a heterogeneous group of tumours that develop from neuroendocrine cells of the pancreas [1]. Pancreatic neu-roendocrine tumours comprise a rare group of pancre-atic tumours and represent about 1–2% of all tumours developing within this organ [2]. The potential of neu-roendocrine cells to produce and secrete peptides and/ or biogenic amines affecting the clinical presentation of the disease thus determines their division into functioning and non-functioning pancreatic neuroendocrine tumours (functioning, F-PTEN and non-functioning, NF-PTEN). General accessibility of cross-sectional imaging of the abdomen has caused a significantly increasing rate of incidentally revealed non-functioning pancreatic neuroendocrine tumours in recent years. The group of NF-PTEN represents the majority of neuroendocrine tumours of the pancreas and is estimated at 60–90% [3]. An asymptomatic pattern of the disease associated with a lack of the peptide and/or biogenic amine productions means that these tumours may present with considerable size at the time of clinical diagnosis. We present a giant non-functioning neuroendocrine tumour of the pancreas successfully treated surgically. Surgical treatment remains the treatment of choice in this group of patients. Long-term results of surgical treatment are superior to those found in exocrine pan-creatic surgery. The overall survival rate is nearly 90% in 5-year follow-up [4, 5]. A 72-year-old male was admitted to the hospital because of a tumour of the pancreas. Three months prior to the hospital admission an ultrasound scan had been performed regarding asymptomatic abdominal pain of unknown aetiology. The examination had demonstrated a tumour in the head of the pancreas about 11.5 cm in size. Besides the intermittent nonspecific abdominal pain, patient did not complain of any other disturbances. He suffered from hypertension and chronic obstructive pulmonary disease (COPD) as comorbidities. The pa-tient's past medical history was notable for cholecystec-tomy and pneumonia a year previously. On admission, his general condition was good. He did not complain of any problems. According to a physical examination, a palpable mass in the epigastric region was revealed. The patient denied weight loss, elevated temperature, jaundice, or problems with bowel movements. Diagnos-tics were implemented. An abdominal computed tomog-raphy (CT) scan and endocrine evaluation was provided. Imaging of abdominal CT scan demonstrated a huge tumour in the right upper quadrant of the abdomen measuring 14 × 11 × 10 cm (Figure 1). The pathological mass demonstrated features of central necrosis and cal-cifications. The enhancement due to CT scan was weak and non-equally distributed. Both the …