Cancer Res Treat.  2013 Jun;45(2):150-154.

Multiple Cardiac Metastases from a Nonfunctioning Pancreatic Neuroendocrine Tumor

• Choi YH
• Han HS
• Lim SN
• Lee SY
• Koo JH
• Lee OJ
• Lee KH
• Kim ST

Abstract

Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which most commonly metastasize to the liver. However, intrathoracic metastases from pNETs are encountered infrequently. This report describes a case of nonfunctioning pNET with multiple cardiac metastases. A 56-year-old male presented with a palpable abdominal mass that showed progressive enlargement. Findings on computed tomography (CT) of the abdomen revealed two relatively well-marginated inhomogeneous low-attenuation masses, one in the head of the pancreas and the other in the tail. Multiple enhancing masses in the left pericardium with myocardial involvement were observed on chest CT and transthoracic echocardiography. Needle biopsies were performed on the mass in the tail of the pancreas and the left ventricular apical pericardium; histologic examination by hematoxylin and eosin morphology and immunohistochemical staining showed pNET in both. This is the first report of pNET with multiple cardiac metastases to previously undescribed metastatic sites.

Keyword

Heart neoplasms; Neoplasm metastasis; Neuroendocrine tumors; Pancreas

MeSH Terms

Abdomen
Biopsy, Needle
Echocardiography
Eosine Yellowish-(YS)
Head
Heart Neoplasms
Hematoxylin
Humans
Liver
Male
Neoplasm Metastasis
Neuroectodermal Tumors, Primitive
Neuroendocrine Tumors
Pancreas
Pericardium
Thorax
Eosine Yellowish-(YS)
Hematoxylin

Figure

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  Fig. 1 Computed tomography (CT) of the abdomen. CT of the abdomen showed well-marginated enhancing large masses, one measuring 7.3×8.8 cm in the head of the pancreas and one measuring 12.0×9.2 cm in the tail.

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  Fig. 2 Computed tomography (CT) of the chest. Chest CT showed multiple enhancing masses distributed in the left pericardium.

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  Fig. 3 Transthoracic two-dimensional echocardiography. Parasternal long axis view (A) and short axis view (B) showing heterogeneous round-shaped masses attached to the pericardium of the interatrial septal groove and the inferolateral wall of the left ventricle, with myocardial involvement. LA, left atrium; LV, left ventricle; Ao, aorta; T, tumor.

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  Fig. 4 Pathologic features of a needle biopsy of the mass in the pancreatic tail. (A) The tumor showed a nesting growth pattern with monotonous cells. The majority of tumor cells had a centrally located nucleus with moderate amounts of amphophilic cytoplasm. Nuclei were generally round to oval in shape, with coarsely clumped chromatin (H&E staining, ×400). Immunohistochemistry showed that the tumor cells were positive for chromogranin (B) and CD56 (C) (B and C, ×100).

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