A primary pancreatic carcinoid tumour with unusual clinical complaints: A case report

BACKGROUND: Unless metastatic or compressing the pancreatic duct, carcinoid of the pancreas are asymptomatic showing normal levels of serotonine and its metabolites in plasma and urine, thus resulting in delayed diagnosis and a consequent poor prognosis. However, if resection is timely accomplished, no local recurrence might be encountered and a normal survival might be expected in the absence of metastatic disease. CASE PRESENTATION: The reported case of pancreatic carcinoid tumour in a 62-year-old woman reporting only atypical symptoms consisting of intermittent epigastric pain and nausea. Urinary 5-hydroxyindolacetic acid levels were within normal limits and only a slight elevation of serum serotonine level was detected on admission. After tumour localisation with endoscopic ultrasonography, left splenopancreasectomy with splenic, celiac and hepatic lymphadenectomy was carried out. CONCLUSION: The role of endoscopic ultrasonography in early detection and precise localisation of pancreatic carcinoids, as well as the role of somatostatin-receptor scintigraphy with (111)Indium labelled pentreotide in excluding distant metastases, are confirmed. The radical resection with lymphadenectomy is recommended in order to have a precise histological examination and detect occult lymph node metastases.