case_images: PMC7544986_01
case_images: Microscopic features assessed by liver biopsy before transformation (A-D), computed tomography (E-G), and endoscopy (H,I) of a grade 2 neuroendocrine tumor (Case 1). (A) Hematoxylin and eosin staining. Immunohistochemistry of (B) Ki-67, (C) synaptophysin, and (D) gastrin. (All x40 magnification). (E) Liver metastasis before transformation (non-functional neuroendocrine tumor [NET]), (F) liver metastasis after transformation into a functional NET [gastrinoma], and (G) duodenal perforation indicated by retroperitoneal free air (arrows). (H) Multiple duodenal ulcers (white arrows) and (I) perforation hole toward the retroperitoneum (black arrow).
case_images: fonc-10-555963-g0001.jpg
case_images: PMC7544986_02_fonc-10-555963-g0001.jpg
case_images: F1
case_images: However, multiple liver tumors continued to grow (Figure 1E). Additionally, computed tomography and endoscopy showed increased liver metastasis (Figure 1F) and perforation of multiple duodenal ulcers (Figures 1G-I).
case_images: PMC7544986_02
case_images: Microscopic features assessed by liver biopsy before transformation (A-D), computed tomography (E-G), and endoscopy (H,I) of a grade 2 neuroendocrine tumor (Case 1). (A) Hematoxylin and eosin staining. Immunohistochemistry of (B) Ki-67, (C) synaptophysin, and (D) gastrin. (All x40 magnification). (E) Liver metastasis before transformation (non-functional neuroendocrine tumor [NET]), (F) liver metastasis after transformation into a functional NET [gastrinoma], and (G) duodenal perforation indicated by retroperitoneal free air (arrows). (H) Multiple duodenal ulcers (white arrows) and (I) perforation hole toward the retroperitoneum (black arrow).
case_images: fonc-10-555963-g0001.jpg
case_images: PMC7544986_02_fonc-10-555963-g0001.jpg
case_images: F1
case_images: However, multiple liver tumors continued to grow (Figure 1E). Additionally, computed tomography and endoscopy showed increased liver metastasis (Figure 1F) and perforation of multiple duodenal ulcers (Figures 1G-I).
case_images: Computed tomography (A) and microscopic features assessed by liver biopsy before transformation (B-E) of a grade 2 neuroendocrine tumor (Case 2). (A) left panel; liver metastasis (arrow) before transformation (functional neuroendocrine tumor [NET; gastrinoma]) and right panel; liver metastasis after transformation into the addition of another functional NET [gastrinoma and insulinoma]. (B) Hematoxylin and eosin staining. Immunohistochemistry of (C) Ki-67, (D) gastrin, and (E) insulin (All x40 magnification).
case_images: fonc-10-555963-g0002.jpg
case_images: PMC7544986_02_fonc-10-555963-g0002.jpg
case_images: F2
case_images: Computed tomography revealed a large tumor in the pancreas body and tail (maximum diameter, 60 mm) and multiple liver tumors (maximum diameter 20 mm) (Figure 2A, left panel). We diagnosed him with pancreatic NET (grade 2, Ki-67 3.7%) with liver metastasis (gastrinoma) based on liver biopsy specimens and clinical findings (Figures 2B,C). Immunohistochemistry analysis further revealed gastrin and insulin negativity in the tumor (Figures 2D,E). Therefore, we changed his treatment to PRRT and sunitinib, but this was discontinued after he experienced multiple duodenal ulcers, duodenal perforation, and exacerbation of the liver metastasis (Figure 2A, right panel).