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Late-Onset Para-Aortic Lymph Node Recurrence 11 Years after Resection of Pancreatic Cancer: Histological Reassessment Revealed Neuroendocrine Differentiation Amenable to Surgical Resection

  • 0Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Institute of Science Tokyo, Tokyo, Japan.
Surgical Case Reports +

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October 8, 2025

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October 8, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Late recurrence of pancreatic cancer can be neuroendocrine. A patient initially diagnosed with pancreatic ductal adenocarcinoma (PDAC) experienced a delayed recurrence 11 years later, which was reclassified as a neuroendocrine tumor (NET) amenable to surgical resection.

Area Of Science

  • Oncology
  • Pathology
  • Surgical Gastroenterology

Background

  • Late recurrence of pancreatic ductal adenocarcinoma (PDAC) is uncommon and typically managed with systemic chemotherapy.
  • Pancreatic neuroendocrine neoplasms (Pan-NENs) can recur over a decade post-surgery and may be resectable.
  • Distinguishing PDAC from Pan-NEN can be challenging, especially in older cases.

Purpose Of The Study

  • To highlight the importance of tissue diagnosis in late-onset recurrence after initial PDAC diagnosis.
  • To emphasize the potential for extremely delayed recurrence in Pan-NENs.
  • To stress the significance of long-term surveillance for patients with a history of pancreatic cancer.

Main Methods

  • A case report of a 77-year-old man initially treated for pancreatic body cancer (diagnosed as PDAC).
  • Imaging revealed a para-aortic lymph node enlargement 11 years post-surgery.
  • CT-guided biopsy and retrospective review confirmed a diagnosis of neuroendocrine tumor-G2 (NET-G2).

Main Results

  • The patient underwent successful surgical resection of metastatic NET-G2 lymph nodes.
  • Histological re-evaluation of the original specimen revealed previously unrecognized NET-G2 components.
  • The patient remains recurrence-free at 7 months post-operatively.

Conclusions

  • Tissue diagnosis is crucial for late-onset recurrences initially diagnosed as PDAC.
  • Pancreatic neuroendocrine neoplasms can have very late recurrences, necessitating long-term surveillance.
  • Biopsy and pathological re-evaluation are vital for appropriate therapeutic decisions in cases of isolated distant recurrence after PDAC treatment.

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