Mixed Neuroendocrine and Non-Neuroendocrine Neoplasm of Pancreas: What Do We Know, What Have We Learnt?

Pancreatic adeno-mixed neuroendocrine non-endocrine (pMINEN) tumors are extremely rare [Pancreatology. 2021;21(1):224-235]. They are known to have distal metastasis at presentation and have a comparatively lower survival rate than similar staged neuroendocrine (NEN) carcinoma, adenocarcinoma, and small-cell lung tumor from which its treatment patterns are extrapolated. Also, very less is known about its molecular structure and natural courses. There is a dearth of data about pMINEN in the literature, and also there is a lack of large multicentral trials due to which the MINEN tumors do not have a standard universal management protocol. We discuss here the clinical dilemmas that arise during diagnosis and reporting and urge to form a multicentric trial to formulate a focused protocolized approach. We describe here our encounter with a pancreatic head lesion which on immunohistochemical analysis turned out to be a pMINEN with moderately differentiating ductal adenocarcinoma and low-grade NEN tumor. Radical R0 surgery with multimodal treatment (chemotherapy + radiotherapy) gains improved survival in long term.

Multiple focal nodular hyperplasia, an incidental finding on autopsy.

Focal nodular hyperplasia (FNH) is a benign condition of the liver often discovered incidentally on radiological investigation. Although FNH is a well-described lesion in the literature considerable diagnostic problems regarding this entity still remains. We report a case of multiple FNH in a 23-year-old male patient detected as an incidental finding in autopsy. On gross examination FNH was not suspected because of the multiple lesions and the lack of central scar which is characteristically described in FNH. The diagnosis was established on histopathology after examination of multiple sections of the lesions.

Choroidal melanoma metastatizing to the biliary system: A diagnostic dilemma.

Metastatic melanoma to the gall bladder is extremely rare and is associated with a very poor prognosis. We report a case of choroidal melanoma metastatizing to the hepatobiliary system, with an unusual presentation. Our patient presenting with obstructive jaundice was misdiagnosed as having carcinoma of the gall-bladder, but the diagnosis of metastatic melanoma to the gallbladder was confirmed by ultrasonography guided fine needle aspiration cytology (USG-FNAC). On reviewing the past history, the patient had a history of enucleation for choroidal melanoma. Even though the liver 'is' a common site for metastasis of choroid melanoma, the patient presenting with a suspected gall bladder mass 'is' a rare presentation. Hence, gastrointestinal symptoms and a history of melanoma should be investigated for the presence of gastrointestinal or liver metastases, even if the original primary malignancy was diagnosed years before the patient's presentation.

Solid pseudopapillary tumor of the pancreas.

Solid pseudopapillary tumor of the pancreas is considered to be a rare pancreatic tumor. These tumors are typically present in women in their third decade of life. The tumors have a low malignant potential. We report a case of 22-year-old female who presented with intermittent abdominal pain of 3 years duration. Distal pancreatectomy with splenectomy was done as a definitive treatment. The importance of accurate diagnosis and treatment is emphasized.