# A Case of a Metastatic Pancreatic Neuroendocrine Tumor: A Surgical Conundrum Wrapped in Functionality's Embrace

## TL;DR

A rare case of a non-functioning pancreatic tumor turning into a functioning one is described, showing how surgery can help manage symptoms temporarily.

## Contribution

The case highlights a rare transformation of a non-functioning tumor into a functioning one and the potential role of surgery in managing symptoms.

## Key findings

- A non-functioning pNET transformed into a functioning one, causing hypoglycemia and diarrhea.
- Surgical intervention temporarily resolved symptoms but disease re-emerged after seven months.
- The case underscores the need for vigilance in monitoring non-functioning pNETs for possible transformation.

## Abstract

This case study reports a rare case of a non-functioning metastatic pancreatic neuroendocrine tumor (pNET) transforming into a functioning pNET. A 59-year-old male, previously treated with distal pancreatectomy, splenectomy, lymph node dissection, liver metastasectomy, and pharmacotherapy, presented with weakness, hypoglycemia, and daily episodes of watery diarrhea. A functioning neuroendocrine liver metastasis expressing insulin and gastrin was identified. Surgical intervention, including left lateral hepatectomy and microwave ablation of multiple intrahepatic lesions, resulted in symptom resolution and uneventful recovery. However, metastatic liver disease re-emerged seven months post-surgery, necessitating chemotherapy. This case highlights the importance of vigilance for symptom development in non-functioning pNETs, signaling potential disease relapse and phenotype transformation, and suggests surgical treatment as a viable option in select cases.