The Pancreas as a Site of Metastasis or Second Primary in Patients with Small Bowel Neuroendocrine Tumors

Ann Surg Oncol. 2019 Aug;26(8):2525-2532. doi: 10.1245/s10434-019-07370-3. Epub 2019 Apr 22.


Background: The small bowel and pancreas are the most common primary sites of neuroendocrine tumors (NETs) giving rise to metastatic disease. Some patients with small bowel NETs (SBNETs) present with synchronous or metachronous pancreatic NETs (PNETs), and it is unclear whether these are separate primaries or metastases from one site to the other.

Methods: A surgical NET database including patients undergoing operations for SBNETs or PNETs was reviewed. Patients with synchronous or metachronous tumors in both the small bowel and pancreas were identified, and available tissues from primary tumors and metastases were examined using a 4-gene quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) panel developed for evaluating NETs of unknown primary.

Results: Of 338 patients undergoing exploration, 11 had NETs in both the small bowel and pancreas. Tissues from 11 small bowel tumors, 9 pancreatic tumors, and 10 metastases were analyzed. qPCR and IHC data revealed that three patients had separate SBNET and PNET primaries, and five patients had SBNETs that metastasized to the pancreas. Pancreatic tissue was unavailable in two patients, and qPCR and IHC gave discrepant results in one patient.

Conclusions: NETs in both the small bowel and pancreas were found in 3% of our patients. In nearly two-thirds of evaluable patients, the pancreatic tumor was a metastasis from the SBNET primary, while in the remaining one-third of patients it represented a separate primary. Determining the origin of these tumors can help guide the choice of systemic therapy and surgical management.

MeSH terms

  • Biomarkers, Tumor / metabolism*
  • Follow-Up Studies
  • Humans
  • Intestinal Neoplasms / metabolism
  • Intestinal Neoplasms / pathology*
  • Intestinal Neoplasms / surgery
  • Intestine, Small / metabolism
  • Intestine, Small / pathology*
  • Intestine, Small / surgery
  • Liver Neoplasms / metabolism
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery
  • Lymphatic Metastasis
  • Neoplasms, Second Primary / metabolism
  • Neoplasms, Second Primary / pathology*
  • Neoplasms, Second Primary / surgery
  • Neuroendocrine Tumors / metabolism
  • Neuroendocrine Tumors / pathology*
  • Neuroendocrine Tumors / surgery
  • Pancreatic Neoplasms / metabolism
  • Pancreatic Neoplasms / secondary*
  • Pancreatic Neoplasms / surgery
  • Prognosis
  • Prospective Studies


  • Biomarkers, Tumor