Retroperitonial Non Functional Neuroendocrine Tumor Of Pancreas Encircling Duodenum Without Obstruction

A 50-year-old lady with the history of generalized weakness and abdominal discomfort for one month was investigated in a local hospital and found to have severe anemia with a hemoglobin level of 3g/dl. She was treated with multiple blood transfusions.Upon admission to our hospital, the patient continued to have abdominal discomfort. On examination there was a single ill-defined mass palpable in the right hypochondrium and right lumbar area. CT of the abdomen revealed a multilobulated mass lesion in the right paraspinal location extending superiorly from the porta hepatics to the aortic bifurcation inferiorly, located anterior to the inferior vena cava and right kidney. There was extrinsic compression of the second and third part of the duodenum in upper GI scopy. On exploratory laprotomy there was a mass in the retroperitonium posterior to the second and third part of the duodenum, anterior to the inferior vena cava and right kidney extending from porta hepatis to right iliac fossa. Part of the tumor was encircling the third part of the duodenum for about 270 degrees, displacing the uncinate process and the head of the pancreas superiorly. The mass was carefully separated from duodenum and pancreas with sharp dissection, and the whole mass was excised completely. Histopathology of the mass was reported as pancreatic neuroendocrine tumor.