Management of neuroendocrine carcinomas of the pancreas (WHO G3): A tailored approach between proliferation and morphology

Figure 1 Pancreatic poorly differentiated neuroendocrine carcinomas of the pancreatic body-tail associated with neoplastic thrombosis of the splenic vein/portal vein, and with a lymphadenopathy along the stomach. The patients underwent left pancreatectomy with splenectomy, portal vein resection with portal vein thrombectomy and partial gastric resection.

Figure 2 A small cell poorly differentiated neuroendocrine carcinoma of the pancreas (A) (haematoxylin-eosin stain) and a small cell poorly differentiated neuroendocrine carcinoma of the pancreas with high ki67 proliferative index (B, Ki67: 90%).

Figure 3 Shows a large cell poorly differentiated neuroendocrine carcinoma of the pancreas (A, haematoxylin-eosin stain) and a large cell poorly differentiated neuroendocrine carcinoma of the pancreas with its Ki67 proliferative index (B, Ki67: 80%).

Figure 4 Morphological well differentiated neuroendocrine carcinoma of the pancreas (A, haematoxylin-eosin stain) and morphological well differentiated neuroendocrine carcinoma of the pancreas with Ki67 proliferative index of 30% (B).

Figure 5 Diagnostic flowchart algorithm in patients with pancreatic neuroendocrine carcinomas.

Figure 6 Different therapeutic options in patients with morphological poorly differentiated neuroendocrine carcinomas of the pancreas. ¹⁸FDG-PET: ¹⁸F-fluorodeoxyglucose positron emission tomography.

Figure 7 Management flowchart algorithm in patients with morphological well differentiated neuroendocrine carcinomas of the pancreas. PRRT: Peptide receptor radionuclide therapy; TAE: Transarterial embolization; TACE: Transarterial chemoembolization; SSA: Somatostatin analogues.