Neuroendocrine tumors of pancreas

  • Functioning or non-functioning depending on hormonal hyper secretion
  • Functioning tumors produce a peptide hormone and has a clinical syndrome
  • Non-functioning tumors have a better prognosis
  • Insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma 
  • 20% NETs are partially cystic, 3% purely cystic
Insulinoma
  • Hypoglycemic episodes
  • Solitary, benign
  • 80% cases <2 cm size
  • Treated by surgical resection
Gastrinoma
  • Second most common NET
  • Causes Zollinger-Ellison syndrome
  • Gastric hyperacidity
  • Recurrent gastric and duodenal ulceration
  • Often multiple
  • 60% malignant
  • Seen in gastrinoma triangle: junction of cystic and common hepatic duct superiorly, second and third parts of duodenum inferiorly, pancreatic neck medially¬†
  • Associated with multiple endocrine neoplasia MEN-1

  • Early enhancement quite often, well seen also in portal phase imaging 
  • Functional imaging useful. PET-CT using somatostatin receptor tracers: Ga 68 DOTATOC / DOTANOC / DOTATATE
  • Invasive techniques like selective arterial calcium stimulation followed by venous sampling is also useful
  • Non functioning  tumors show calcification and avid contrast enhancement.