Tumores neuroendocrinos de páncreas debutando como ampuloma: reporte de un caso y revisión del abordaje diagnóstico actual Neuroendocrine tumors of the pancreas appearing as ampulomas: report of one case and review of the current diagnostic approach

Objective: To demonstrate a clinical-surgical exercise of the current diagnostic approach for the treatment of a neuroendocrine tumor of the pancreas, with satisfactory results in a selected patient. Setting: Centro Medico ISSEMYM (Third level health care). Design: Case report. Description of the case: A 42-year-old woman with diagnosis of acute pancreatitis, bilirubins indicated an obstructive pattern, retrograde endoscopic cholangiopancreatography was performed that revealed an image suggestive of ulcerated ampuloma; the histopathological report referred: poorly differentiated adenocarcinoma. During evolution, the patient presented cholangitis, which required treatment and a new retrograde endoscopic cholangiopancreatography with esphyncterotomy, choledochus cleaning with balloon, and placement of a plastic French 10 endoprosthesis, with good clinical response. Pancreatoduodenectomy was programmed, fi nding a pancreatic uncinate process tumor and a tumor in the second portion of the duodenum, the transoperative report corresponded to a neuroendocrine tumor. Conclusion: Neuroendocrine tumors of the pancreas are rare neoplasms, with a literature reported incidence of less than 1 per 100,000 people per year. They originate from pluripotent cells within the exocrine pancreas and constitute <2% of all pancreatic Resumen Objetivo: Demostrar un ejercicio clinico-quirurgico del abordaje diagnostico actual para el tratamiento de tumor neuroendocrino de pancreas con resultados satisfactorios en un paciente seleccionado. Sede: Centro Medico ISSEMYM (Tercer nivel de atencion). Diseno: Reporte de caso. Descripcion del caso: Mujer de 42 anos con diagnostico de pancreatitis aguda, las bilirrubinas mostraban patron obstructivo. Se realizo colangiopancreatografia endoscopica retrograda mostrando imagen sugestiva de ampuloma ulcerado; el reporte histopatologico refi rio: adenocarcinoma pobremente diferenciado. En el curso de su evolucion presento colangitis, que requirio tratamiento con nueva realizacion de colangiopancreatografia endoscopica retrograda con esfi nterotomia, aseo coledocal con balon y colocacion de endoprotesis plastica 10 French, con buena respuesta clinica. Se programo pancreatoduodenectomia, encontrando tumoracion en proceso uncinado de pancreas y tumor en segunda porcion de duodeno, cuyo reporte transoperatorio fue tumor neuroendocrino. Conclusion: Los tumores neuroendocrinos de pancreas son neoplasias poco comunes, cuya incidencia reportada en la literatura especializada es <1 por cada 100,000 personas por ano. Provienen de celulas pluripotenciales dentro del pancreas