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A Case of Curative Resection by Minimally Invasive Surgery in Two Stages Using the Hormonal Mapping Test for
Shohei Motohashi1, Daisuke Asano1, Satoshi Matsui1
1Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Institute of Science Tokyo, Tokyo, Japan.
Introduction:
Symptom control is sometimes as important as tumor burden control in patients with functional neuroendocrine tumors (NETs). The selective arterial calcium injection (SACI) test is widely used to localize functional NETs, particularly insulinomas and gastrinomas; however, its utility in adrenocorticotropic hormone (ACTH)-producing tumors (ACTHomas) remains unclear. We present a case of a pancreatic head ACTHoma with synchronous liver metastases in which the SACI test with venous sampling ("hormonal mapping") enabled a safe, staged curative resection.
Case Presentation:
A 42-year-old woman presented with features of Cushing's syndrome, including edema and weight gain. CT revealed a pancreatic head tumor with multiple liver metastases. Liver biopsy confirmed the diagnosis of NET, suggesting an ACTHoma. Hormonal mapping demonstrated that liver metastases, rather than the pancreatic tumor, were the predominant sources of ACTH secretion. To achieve hormonal control, we prioritized laparoscopic liver resection, followed by laparoscopic pancreatoduodenectomy three months later after confirming the absence of new metastatic lesions. At 21 months postoperatively, the patient remains recurrence-free.
Conclusions:
Hormonal mapping was effective in identifying hormone-producing lesions and guiding surgical strategies for ACTHomas with liver metastases.
Insights
Selective arterial calcium injection (SACI) testing, or hormonal mapping, successfully localized ectopic adrenocorticotropic hormone (ACTH) secretion in a patient with an ACTH-producing tumor (ACTHoma) and liver metastases, guiding curative surgery.
Area of Science:
- Endocrinology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Symptom control is crucial in functional neuroendocrine tumors (NETs).
- Selective arterial calcium injection (SACI) is used for localizing NETs like insulinomas and gastrinomas.
- The utility of SACI for ACTH-producing tumors (ACTHomas) is not well-established.
