P1111 - Metastatic Pancreatic Neuroendocrine Tumor With Liver Involvement: An Unusual Presentation

Fatima Ahson, MD, Oscar Hernandez, MD
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL

Introduction: This case report focuses on a 40-year-old primigravid woman who presented with diffuse itching and jaundice, leading to the diagnosis of acute liver failure from HELLP syndrome. Further investigations revealed a multifocal poorly differentiated carcinoma with lymphovascular invasion involving three lymph nodes, along with preliminary findings suggestive of a metastatic pancreatic neuroendocrine tumor with liver involvement.

Case Description/Methods: A 40-year-old primigravid woman presented with diffuse itching and jaundice, accompanied by elevated transaminases and bilirubin. Concerns for pre-eclampsia prompted a c-section, and the initial diagnosis was acute liver failure from HELLP syndrome. Due to the severity of her liver dysfunction, she was transferred to Jackson Memorial, a tertiary liver transplant center. Further workup at Jackson Memorial revealed multifocal poorly differentiated carcinoma with lymphovascular invasion involving three lymph nodes. She was found to have 90% malignancy of her liver. Preliminary pathology reports indicate possible metastatic pancreatic neuroendocrine tumor with liver involvement.

Discussion: This case highlights the complex nature of the patient’s condition. Initial symptoms of diffuse itching and jaundice led to the diagnosis of acute liver failure from HELLP syndrome. However, subsequent investigations unveiled an unexpected finding of multifocal poorly differentiated carcinoma with lymphovascular invasion, suggesting aggressive tumor behavior and potential metastasis. Preliminary pathology results suggest a metastatic pancreatic neuroendocrine tumor with liver involvement. The coexistence of HELLP syndrome and a metastatic malignancy presents challenges in diagnosis and management, warranting further research into potential interrelationships between these conditions. A multidisciplinary approach involving obstetricians, hepatologists, oncologists, and pathologists is crucial for optimal patient care. Further research is needed to explore potential relationships between these conditions and their underlying mechanisms. Timely recognition, appropriate management, and continued monitoring are vital in addressing the complexity of this case.


Disclosures:


Fatima Ahson, MD, Oscar Hernandez, MD. P1111 - Metastatic Pancreatic Neuroendocrine Tumor With Liver Involvement: An Unusual Presentation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.