Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4327-4335
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4327
Pancreatic neuroendocrine carcinoma in a pregnant woman: A case report and review of the literature
Li-Ping Gao, Gui-Xiang Kong, Xiang Wang, Hui-Min Ma, Fei-Fei Ding, Ting-Dong Li
Li-Ping Gao, Gui-Xiang Kong, Xiang Wang, Hui-Min Ma, Fei-Fei Ding, Department of Gastroenterology, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Ting-Dong Li, Department of Musculoskeletal Tumor, Gansu Provincial Cancer Hospital, Lanzhou 730000, Gansu Province, China
Author contributions: Gao LP and Wang X were attending physicians for the patient, reviewed the literature, and contributed to manuscript drafting; Ma HM and Ding FF reviewed the literature and contributed to manuscript drafting; Kong GX performed the upper gastrointestinal endoscopy and colonoscopy, and contributed to manuscript drafting; Li TD was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ting-Dong Li, MAMS, Doctor, Department of Musculoskeletal Tumor, Gansu Provincial Cancer Hospital, No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730000, Gansu Province, China. ltd200998@163.com
Received: January 13, 2021
Peer-review started: January 13, 2021
First decision: February 10, 2021
Revised: February 23, 2021
Accepted: April 6, 2021
Article in press: April 6, 2021
Published online: June 16, 2021
Processing time: 132 Days and 21 Hours
Abstract
BACKGROUND

Portal venous thromboembolism caused by malignant pancreatic neuroendocrine tumor metastasis, as the initial presentation of portal hypertension and upper gastrointestinal bleeding, is a rare entity. To our knowledge, there are no reports of this entity in pregnant women. We describe a case of pancreatic neuroendocrine carcinoma during pregnancy with hematemesis and hematochezia as the initial presentation and review the literature to analyze the demographic, clinical, and pathological features to provide a reference for clinical diagnosis and treatment.

CASE SUMMARY

A 40-year-old woman presented with hematemesis and hematochezia at 26-wk gestation; she had no other remarkable medical history. The physical examination revealed normal vital signs, an anemic appearance, and lower abdominal distension. Abdominal color Doppler ultrasonography showed portal vein thrombosis, splenomegaly, intrauterine pregnancy, and intrauterine fetal death. Esophagogastroduodenoscopy revealed esophageal and gastric varicose veins and portal hypertensive gastropathy. Contrast-enhanced computed tomography demonstrated multiple emboli formation in the portal and splenic veins, multiple round shadows in the liver with a slightly lower density, portal vein broadening, varicose veins in the lower esophagus and gastric fundus, splenomegaly, bilateral pleural effusion, ascites and pelvic effusion, broadening of the common bile duct, and increased uterine volume. According to the results of Positron emission tomography-computed tomography and immunohistochemical staining, the final diagnoses were that the primary lesion was a pancreatic neuroendocrine tumor and that there were secondary intrahepatic metastases and venous cancer thrombogenesis.

CONCLUSION

Upper gastrointestinal bleeding in a pregnant woman may be caused by portal hypertension due to a malignant pancreatic neuroendocrine tumor.

Keywords: Pregnancy; Portal venous thromboembolism; Pancreatic neuroendocrine carcinoma; Portal hypertension; Gastrointestinal bleeding; Case report

Core Tip: Upper gastrointestinal bleeding caused by portal hypertension is a rare form of advanced pancreatic neuroendocrine tumor. Our patient presented with hematemesis and hematochezia at 26-wk gestation, but no other significant medical history. Positron emission tomography-computed tomography revealed that lesions in the liver were found to be pancreatic neuroendocrine carcinoma during pregnancy. This case demonstrates that upper gastrointestinal bleeding as the initial presentation should be suspected among pregnant patients at high risk for malignancies.