Document Type : Brief Report(s)


1 Department of Gastroenterology, Shifa International Hospital, Islamabad, Pakistan

2 Department of Surgery, Shifa International Hospital, Islamabad, Pakistan

3 Department of Pathology, Shifa International Hospital, Islamabad, Pakistan

4 Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan


Background: Pancreatic neuroendocrine tumors (P-NETs) constitute a subset of pancreatic mass lesions characterized by diverse clinical presentations. Despite their inherent malignant potential, the timely identification and treatment of these tumors are critical for achieving favorable clinical outcomes. This study aims to shed light on the heterogeneous tumor biology of P-NETs and the management strategies employed at a tertiary care center in Pakistan.
Method: A retrospective study encompassing all patients with a biopsy-confirmed diagnosis of P-NETs at Shifa International Hospital between January 1st, 2016, and June 30th, 2021, was conducted. Meticulous data extraction from pathology records and thorough searches of medical records were performed to gather relevant demographic and clinical information.
Results: A total of 24 patients were retrieved from our database, with 13 (54%) female patients. The mean age was 49.5 ± 16.3 years. Eight out of the 24 patients presented with abdominal pain. Most patients (14 out of 24) had lesions in the pancreatic head region. In three cases, lesions exhibited multicentricity. The mean lesion size measured 4.4 ± 2.3 cm. Three of the 24 patients displayed distant liver metastasis at the presentation time. 19 out of the 24 patients underwent surgical resections, while endoscopic ultrasound (EUS)-guided biopsy was performed in 4 out of 24 cases. EUS-guided tissue biopsy yielded accurate diagnoses in all four cases.
Conclusion: Most P-NETs are non-functional, and there is an almost equal distribution between male and female patients. Solitary lesions predominate, and metastasis is uncommon at initial presentation. EUS-guided fine needle biopsy stands out as a dependable diagnostic modality for P-NETs.


Muslim Atiq (PubMed)


Main Subjects

How to cite this article:

Akhlaq K, Khan H, Ali Z, Atiq M, Riyaz S, Raja UY, et al. Pancreatic neuroendocrine tumors: spectrum of clinical presentation from a tertiary referral center in Pakistan. Middle East J Cancer. 2024;15(2):145-52. doi:10.30476/mejc.2023.98055.1883.

  1. Ro C, Chai W, Yu VE, Yu R. Pancreatic neuroendocrine tumors: biology, diagnosis, and treatment. Chin J Cancer. 2013;32(6):312–24. doi: 10.5732/cjc.012.10295.
  2. Gaujoux S, Menegaux F. Going above and beyond the pancreatic neuroendocrine tumor classification. JCO Oncol Pract. 2020;16(11):731-2. doi:10.1200/OP.20.00809.
  3. Stevenson M, Lines KE, Thakker RV. Molecular genetic studies of pancreatic neuroendocrine tumors: New therapeutic approaches. Endocrinol Metab Clin North Am. 2018;47(3):525-48. doi: 1016/j.ecl.2018.04.007.
  4. Lee L, Ito T, Jensen RT. Imaging of pancreatic neuroendocrine tumors: recent advances, current status, and controversies. Expert Rev Anticancer Ther. 2018;18(9):837-60. doi: 10.1080/14737140.2018.1496822
  5. Sadowski SM, Neychev V, Millo C, Shih J, Nilubol N, Herscovitch P, et al. Prospective study of 68Ga-DOTATATE positron emission tomography/computed tomography for detecting gastro-entero-pancreatic neuroendocrine tumors and unknown primary sites. J Clin Oncol. 2016;34(6):588-96. doi: 10.1200/JCO.2015.64.0987.
  6. Di Leo M, Poliani L, Rahal D, Auriemma F, Anderloni A, Ridolfi C, et al. Pancreatic neuroendocrine tumours: the role of endoscopic ultrasound biopsy in diagnosis and grading based on the WHO 2017 classification. Dig Dis. 2019;37(4):325-33. doi: 10.1159/000499172.
  7. Tang LH, Basturk O, Sue JJ, Klimstra DS. A practical approach to the classification of WHO grade 3 (G3) well-differentiated neuroendocrine tumor (WD-NET) and poorly differentiated neuroendocrine carcinoma (PD-NEC) of the pancreas. Am J Surg Pathol. 2016;40(9):1192-202. doi: 10.1097/PAS.0000000000000662.
  8. Han X, Zhang C, Tang M, Xu X, Liu L, Ji Y, et al. The value of serum chromogranin A as a predictor of tumor burden, therapeutic response, and nomogram-based survival in well-moderate nonfunctional pancreatic neuroendocrine tumors with liver metastases. Eur J Gastroenterol Hepatol. 2015;27(5):527-35. doi: 10.1097/MEG.0000000000000332.
  9. Pulvirenti A, Rao D, Mcintyre CA, Gonen M, Tang LH, Klimstra DS, et al. Limited role of Chromogranin A as clinical biomarker for pancreatic neuroendocrine tumors. HPB (Oxford). 2019;21(5):612-8. doi: 10.1016/j.hpb.2018.09.016.
  10. Thoeni RF, Mueller-Lisse UG, Chan R, Do NK, Shyn PB. Detection of small, functional islet cell tumors in the pancreas: selection of MR imaging sequences for optimal Radiology. 2000;214(2):483-90. doi: 10.1148/radiology.214.2.r00fe32483.
  11. Choi TW, Kim JH, Yu MH, Park SJ, Han JK. Pancreatic neuroendocrine tumor: prediction of the tumor grade using CT findings and computerized texture analysis. Acta Radiol. 2018;59(4):383-92. doi: 10.1177/0284185117725367.
  12. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. 2016;103(2):153-71. doi: 10.1159/000443171.
  13. Graham MM, Gu X, Ginader T, Breheny P, Sunderland JJ. 68Ga-DOTATOC imaging of neuroendocrine tumors: a systematic review and metaanalysis. J Nucl Med. 2017;58(9):1452-8. doi: 10.2967/jnumed.117.191197.
  14. Chouliaras K, Newman NA, Shukla M, Swett KR, Levine EA, Sham J, et al. Analysis of recurrence after the resection of pancreatic neuroendocrine tumors. J Surg Oncol. 2018;118(3):416-21. doi: 10.1002/jso.25146.
  15. Lee L, Ito T, Jensen RT. Prognostic and predictive factors on overall survival and surgical outcomes in pancreatic neuroendocrine tumors: recent advances and controversies. Expert Rev Anticancer Ther. 2019;19(12):1029-50. doi: 10.1080/14737140.2019.1693893.
  16. Ali J, Rahat A, Shah MH, Sajjad M, Malik I, Ikram SI, et al. The clinicopathologic characteristics and outcomes of gastroentero-pancreatic neuroendocrine tumors - experience from a tertiary cancer center. Gulf J Oncolog. 2022;1(40):7-14
  17. Krogh S, Grønbæk H, Knudsen AR, Kissmeyer-Nielsen P, Hummelshøj NE, Dam G. Predicting progression, recurrence, and survival in pancreatic neuroendocrine tumors: a single center analysis of 174 patients. Front Endocrinol (Lausanne). 2022;13:925632. doi: 10.3389/fendo.2022.925632.
  18. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335-42. doi: 10.1001/jamaoncol.2017.0589.