P029 and OC1
Surgery or no surgery in a patient with MEN 1 with an asymptomatic pancreatic mass
Troke R, Badman M, Simpson K, Palazzo FF and Todd JF.
Department of Endocrinology, Hammersmith and Charing Cross Hospitals, Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS
This patient is a 52 year old lady with MEN 1 (mutation Exon-4 of the MEN1 gene) who presented in 2008, aged 51 years, with hypercalcaemia and a diagnosis of primary hyperparathyroidism was confirmed. She underwent a subtotal parathyroidectomy in September 2008 during which 3 parathyroid glands were removed. The histology of two of these glands revealed hyperplasia. In March 2008, abdominal CT scan revealed a 2.6 cm cystic lesion in the tail of the pancreas and two hyperechogenic lesions - one of 10mm and the other 14mm in the neck and body of the pancreas respectively. All these lesions were consistent with neuroendocrine tumours. Her fasting gut hormones are normal, apart from a raised chromogranin B at 292 pmol/L (NR <150). Octreotide scan did not show any abnormal uptake. Since this lady was so well and the lesions were not producing any active hormones, initially, it was felt that a repeat abdominal scan should be repeated at a six month interval and that surgery should be advised if the cystic lesion had increased in size or become secretory. She was on no regular medication.
The repeat CT scan of her pancreas with contrast showed no changes in appearances in any of the pancreatic lesions or in the other upper abdominal viscera compared to the previous scan and no evidence of metastatic disease or lymphadenopathy. Her fasting gut hormones remain normal apart from a persistently raised Chromogranin B and she remains well. However, even though there is no evidence of hyperfunction, once a lesion is more that 2 cm in size, the rise of malignancy/metastases increases and therefore, on size criteria, we feel that this patient should be offered surgery in the form of a distal pancreatectomy.