ABSTRACT
Pancreatic adeno-mixed neuroendocrine non-endocrine (pMINEN) tumors are extremely rare [Pancreatology. 2021;21(1):224-235]. They are known to have distal metastasis at presentation and have a comparatively lower survival rate than similar staged neuroendocrine (NEN) carcinoma, adenocarcinoma, and small-cell lung tumor from which its treatment patterns are extrapolated. Also, very less is known about its molecular structure and natural courses. There is a dearth of data about pMINEN in the literature, and also there is a lack of large multicentral trials due to which the MINEN tumors do not have a standard universal management protocol. We discuss here the clinical dilemmas that arise during diagnosis and reporting and urge to form a multicentric trial to formulate a focused protocolized approach. We describe here our encounter with a pancreatic head lesion which on immunohistochemical analysis turned out to be a pMINEN with moderately differentiating ductal adenocarcinoma and low-grade NEN tumor. Radical R0 surgery with multimodal treatment (chemotherapy + radiotherapy) gains improved survival in long term.
ABSTRACT
Splenic vein (SV) ligation may be needed during portomesenteric junction resection, in pancreatoduodenectomy. Sinistral portal hypertension is a concern if the SV is not drained. Various techniques are described to reconstruct SV to avoid the variceal formation and sinistral portal hypertension which may lead to GI bleed. We describe a case of a 19-year-old female who underwent pancreatoduodenectomy for solid pseudopapillary neoplasm with portal-superior mesenteric vein junction resection and splenic venous was anastomosed into the interposition graft. We here share our unique experience of using an interposition internal jugular vein graft for a long venous defect and diverging morbidity of sinistral portal hypertension.
