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Case Report Open Access

Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report

  • Authors:
    • Luisa Fernanda Montemayor Burrola
    • Hugo Alberto Roblero López
    • América Villalobos Ulate
    • Edgar Iván Martínez Rosales
  • View Affiliations / Copyright

    Affiliations: Department of Internal Medicine, General Regional Hospital No. 1, Mexican Institute of Social Security (IMSS), Chihuahua, Chihuahua 31000, Mexico
    Copyright: © Montemayor Burrola et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 72
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    Published online on: September 26, 2025
       https://doi.org/10.3892/mi.2025.271
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Abstract

Pancreatic neuroendocrine tumors (PanNETs) are rare malignant neoplasms characterized by slow growth and variable clinical presentation. Although some secrete functional hormones, the majority remain clinically silent or manifest with non‑specific symptoms, posing a challenge to early diagnosis. The present study describes the case of a 52‑year‑old female patient with a significant family history of malignancy, who presented with a syncopal episode following months of weight loss, fatigue and vague abdominal symptoms. A diagnostic workup revealed severe anemia and imaging findings consistent with metastatic disease. A computed tomogrpaphy‑guided liver biopsy confirmed a moderately differentiated, grade II neuroendocrine tumor. Treatment with intramuscular octreotide was initiated, and the patient was discharged under palliative care. The case described herein underscores the clinical complexity and often subtle nature of PanNETs, and highlights the importance of considering them in the differential diagnosis of persistent constitutional symptoms, particularly in high‑risk individuals. Timely diagnosis supported by histopathology and immunohistochemistry, combined with access to targeted therapies, is essential to improve the outcomes of patients. The integration of molecular screening and emerging therapeutic targets may transform the management of PanNETs, enabling earlier and more personalized interventions in the near future.
View Figures

Figure 1

Contrast-enhanced abdominal and pelvic
computed tomography scan. (A) Coronal view illustrating areas of
fat stranding in the perihepatic region, compatible with fluid
overload. (B) Axial view demonstrates heterogeneous liver
parenchyma due to multiple isodense lesions with central
hypodensity suggestive of necrosis (indicated by black arrows).
Following contrast administration, the lesions exhibited
homogeneous centripetal enhancement. No retroperitoneal
lymphadenopathy or lesions were observed.

Figure 2

Immunohistochemical analysis of the
biopsied tissue (magnification, x40). Histological specimens
illustrating neoplastic cells with cylindrical and cuboidal
morphology, irregular nuclear enlargement, inconspicuous nucleoli
and scant cytoplasm. Three mitotic figures per high-power field
(40X objective) are identified. Findings are consistent with
moderately differentiated adenocarcinoma associated with extensive
desmoplasia. (A) CK7 immunohistochemistry: 0% expression, negative
intensity. (B) CK20: 0% expression, negative intensity. (C) CK19:
90% of cells positive, 80% intensity, cytoplasmic pattern. (D)
MUC5AC: 0% expression, negative intensity. (E) CA 19-9: 0%
expression, negative intensity. (F) Chromogranin A: 100%
expression, 90% intensity, cytoplasmic pattern. (G) Synaptophysin:
100% expression, 90% intensity, cytoplasmic pattern. (H) Ki-67:
proliferation index of 8%, 100% intensity, nuclear pattern. (A, B,
D and E) The thin orange rectangle outlines the evaluated area with
no staining (negative expression). C, F and G) Red arrows indicate
cells with brown cytoplasmic staining (positive cytoplasmic
pattern). (H) Thin red circles indicate nuclei with brown nuclear
staining (positive nuclear pattern, 8%).
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Spandidos Publications style
Montemayor Burrola LF, Roblero López HA, Ulate AV and Martínez Rosales EI: Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report. Med Int 5: 72, 2025.
APA
Montemayor Burrola, L.F., Roblero López, H.A., Ulate, A.V., & Martínez Rosales, E.I. (2025). Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report. Medicine International, 5, 72. https://doi.org/10.3892/mi.2025.271
MLA
Montemayor Burrola, L. F., Roblero López, H. A., Ulate, A. V., Martínez Rosales, E. I."Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report". Medicine International 5.6 (2025): 72.
Chicago
Montemayor Burrola, L. F., Roblero López, H. A., Ulate, A. V., Martínez Rosales, E. I."Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report". Medicine International 5, no. 6 (2025): 72. https://doi.org/10.3892/mi.2025.271
Copy and paste a formatted citation
x
Spandidos Publications style
Montemayor Burrola LF, Roblero López HA, Ulate AV and Martínez Rosales EI: Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report. Med Int 5: 72, 2025.
APA
Montemayor Burrola, L.F., Roblero López, H.A., Ulate, A.V., & Martínez Rosales, E.I. (2025). Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report. Medicine International, 5, 72. https://doi.org/10.3892/mi.2025.271
MLA
Montemayor Burrola, L. F., Roblero López, H. A., Ulate, A. V., Martínez Rosales, E. I."Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report". Medicine International 5.6 (2025): 72.
Chicago
Montemayor Burrola, L. F., Roblero López, H. A., Ulate, A. V., Martínez Rosales, E. I."Atypical presentation and diagnosis of a metastatic grade II pancreatic neuroendocrine tumor in a 52‑year‑old female patient: A case report". Medicine International 5, no. 6 (2025): 72. https://doi.org/10.3892/mi.2025.271
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