Differential Diagnosis for Pancreatic Neuroendocrine Tumor with Hepatic Lesions
- Single Most Likely Diagnosis
- Metastatic Pancreatic Neuroendocrine Tumor (PNET): The presence of a primary tumor in the pancreatic distal body/tail and additional DOTATATE-avid foci in the proximal pancreatic body and liver suggests metastatic disease. The high SUVmax values of the lesions also support this diagnosis.
- Other Likely Diagnoses
- Primary Hepatic Neuroendocrine Tumor: Although less likely, it is possible that the hepatic lesions represent a primary neuroendocrine tumor. However, the presence of a primary tumor in the pancreas makes this less likely.
- Gastrointestinal Neuroendocrine Tumor with Metastasis: The involvement of the adjacent inferior proximal gastric wall by the primary tumor raises the possibility of a gastrointestinal neuroendocrine tumor with metastasis to the liver.
- Do Not Miss Diagnoses
- Insulinoma with Metastasis: Although rare, insulinomas can present with metastatic disease. Missing this diagnosis could lead to delayed treatment and potentially life-threatening hypoglycemia.
- Glucagonoma with Metastasis: Similarly, glucagonomas can present with metastatic disease and require prompt treatment to prevent complications.
- Rare Diagnoses
- Composite PNET with Other Tumor Types: Rarely, PNETs can be composite tumors with other neoplastic components, such as adenocarcinoma or acinar cell carcinoma.
- Neuroendocrine Carcinoma with Metastasis: Neuroendocrine carcinomas are rare and aggressive tumors that can present with metastatic disease. Although unlikely, this diagnosis should be considered in the differential.