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Incidentally detected pancreatic neuroendocrine microadenoma with lymph node metastasis


Pancreatic neuroendocrine microadenomas (NEMAs) are non-functioning neuroendocrine tumors < 0.5 cm with a low proliferation rate and are considered benign. We report on a pancreatic NEMA with lymph node metastasis. A male in his 70s had pylorus-preserving pancreaticoduodenectomy for a distal bile duct carcinoma, which was a 2.1 cm well-differentiated-infiltrating adenocarcinoma with invasion limited to the bile duct wall. An incidental separate 0.4 cm well-differentiated NEMA was found in the pancreatic head with metastatic well-differentiated neuroendocrine tumor in one peripancreatic lymph node. Both neuroendocrine tumors in the pancreatic head and in the lymph node were composed of nests of uniform neoplastic cells with a fine chromatin pattern. The Ki-67 labeling index of NEMA was 0.85%. The neoplastic neuroendocrine cells in both the pancreas and node were diffusely positive for synaptophysin, chromogranin, and insulin. Therefore, this unusual case provides an exception to the current classification system which regards NEMAs as benign lesions.

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The study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2016R1A2B4009381), a grant (2013–554) from the Asan Institute for Life Sciences, Seoul, Republic of Korea (SMH), the 2016 Basic/Translational Science Investigator Award from the North American Neuroendocrine Tumor Society supported by the Neuroendocrine Tumor Research Foundation (CMH), and NIH grant CA62924 (RHH).

Author information

Jeong-Hwa Kwon: study design, tissue sampling, drafting of the manuscript

Hyoung Jung Kim: analysis of clinical features

Do Hyun Park: tissue sampling, analysis of clinical features

Young-Joo Lee: tissue sampling, analysis of clinical features

Christopher M. Heaphy: histological analysis, drafting of the manuscript

Günter Klöppel: histological analysis, interpretation of data

Ralph H. Hruban: histological analysis, interpretation of data, drafting of the manuscript

Seung-Mo Hong: study design, histological analysis, interpretation of data, drafting of the manuscript, study supervision

Correspondence to Seung-Mo Hong.

Ethics declarations

Institutional Review Board approval (Approval No.: 2018-0821)

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

This study has been presented, in part, at the 14th Annual ENETS Conference, Barcelona, Spain, March 8–10, 2017.

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Kwon, J., Kim, H.J., Park, D.H. et al. Incidentally detected pancreatic neuroendocrine microadenoma with lymph node metastasis. Virchows Arch 473, 649–653 (2018).

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  • Pancreas
  • Neuroendocrine
  • Microadenoma
  • Lymph node
  • Metastasis
  • Malignant