TOTAL PANCREATECTOMY FOR PANCREATIC MIXED NEUROENDOCRINE-NON-NEUROENDOCRINE NEOPLASM (MINEN): A CASE REPORT
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Abstract
Objective: To report a rare case of pancreatic MINEN combining small cell neuroendocrine carcinoma (SCNEC) and poorly differentiated pancreatic ductal adenocarcinoma (PDAC), discuss the challenges in diagnosis, chemotherapy selection, and surgical decision-making, and contribute to the scarce literature on this entity.
Subjects and methods: A retrospective case report of a patient diagnosed and treated for pancreatic MINEN at the Department of Oncology and Radiotherapy, Viet Duc University Hospital, between January and September 2023.
Results: A 56-year-old male underwent preoperative biopsy confirming SCNEC of the head and body of the pancreas, followed by six cycles of Etoposide-Cisplatin with disease progression. Following multidisciplinary tumor board review, the patient underwent total pancreatectomy with splenectomy (operative time 8 hours 51 minutes) with an uneventful postoperative course and discharge on postoperative day 13. Final pathology confirmed pancreatic MINEN comprising 70% SCNEC and 30% poorly differentiated PDAC, with lymph node metastases in 20 of 24 nodes. Adjuvant mFOLFOX6 was initiated but disease progressed; overall survival following surgery was approximately three months.
Discussion: Preoperative diagnosis of MINEN was limited by sampling error, with the 30% PDAC component identified only on the surgical specimen. Both Etoposide-Cisplatin and mFOLFOX6 were consistent with current NCCN 2025 recommendations yet failed to control disease progression. While the operation was technically successful, survival benefit was limited — reflecting the compounded aggressiveness of two of the most malignant cell lineages coexisting within a single tumor.
Conclusion: This case contributes to the sparse literature on pancreatic MINEN, highlighting three key issues: complete diagnosis is virtually achievable only on surgical specimens; disease may progress despite guideline-concordant chemotherapy due to the inherently aggressive biology of this entity; and the realistic goals of surgery must be thoroughly discussed with patients within a multidisciplinary framework.
Keywords
MINEN, SCNEC, PDAC, total pancreatectomy, neoadjuvant chemotherapy
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References
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