Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2025; 17(6): 105904
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.105904
Pancreato-hepatobiliary neuroendocrine tumors diagnosed through endoscopic ultrasound: Clinical characteristics and factors associated with high-grade lesions
Abbas A Tasneem, Nasir H Luck, Muhammed Mubarak
Abbas A Tasneem, Nasir H Luck, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Author contributions: Tasneem AA, Luck NH, and Mubarak M performed relevant research and participated in primary and final drafting; Luck NH, and Mubarak M critically reviewed and approved the final manuscript. Tasneem AA, Luck NH, and Mubarak M contributed equally to the conception and study design.
Institutional review board statement: The present study was exempted from the Institutional Review Board of Sindh Institute of Urology and Transplantation and was approved by the Head of the Gastroenterology and Hepatology Department, and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: All authors declared that they have no conflict of interest related to this work.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammed Mubarak, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Received: February 10, 2025
Revised: March 21, 2025
Accepted: April 7, 2025
Published online: June 16, 2025
Processing time: 121 Days and 16.7 Hours
Abstract
BACKGROUND

Neuroendocrine tumors (NETs) are an important type of neoplastic disease of the digestive tract. There is little data on NETs originating from the pancreato-hepatobiliary region of the digestive tract in Pakistan.

AIM

To evaluate different types of pancreato-hepatobiliary NETs (PHB-NET) diagnosed with endoscopic ultrasound (EUS) and to identify factors associated with high-grade NETs.

METHODS

All patients diagnosed with PHB-NET through EUS-guided biopsy were included in the study. The site of origin, histology, and grade of PHB-NETs were noted and factors associated with high-grade lesions were analyzed. SPSS, version 20.0 was used for statistical analysis.

RESULTS

A total of 36 patients with PHB-NET were included. Males and females were equal in numbers, i.e., 18 (50%) each. The mean age was 48 ± 15.7 years with an age range of 17-70 years. The most common sites of origin of PHB-NET were: Pancreas 20 (55.6%), porta hepatis mass 8 (22.2%), perigastric mass 3 (8.3%) and others 5 (13.9%). The mean size of the PHB-NETs was 34.7 ± 22.5 mm. Among pancreatic NETs, the most commonly affected areas were body 9, tail 5, and head 5. Only 4 (11.1%) PHB-NETs were functioning, all of which were insulinomas originating from the body or tail of the pancreas. Two-thirds of PHB-NETs, 24 (66.6%), were benign (WHO grade I: 19; grade 2: 5) while one-third 12 (33.3%) were neuroendocrine cancers (NEC) (WHO grade III). Histological types were large cell 17 (47.2%), small cell 8 (22.2%), mixed 1 (2.8%), and undetermined 10 (27.8%). Factors associated with NECs were age > 40 years (P = 0.016), extra-pancreatic origin of the lesion (P = 0.014), and small cell histologic type (P < 0.001).

CONCLUSION

The most common site of PHB-NET detected through EUS was the pancreas. Although most were benign, about one-third were high-grade cancers. Insulinoma was the most common functioning tumor. NECs were associated with advanced age, extra-pancreatic origin, and small-cell histology.

Keywords: Neuroendocrine tumors; Pancreato-hepatobiliary; Endoscopic ultrasound; Clinical characteristics

Core Tip: Pancreato-hepatobiliary neuroendocrine tumors (PHB-NETs) are now mostly diagnosed via endoscopic ultrasound (EUS), with the pancreas being the most frequent site. While most PHB-NETs are benign, one-third are high-grade neuroendocrine cancers (NECs). Insulinomas are the predominant functioning neuroendocrine tumors. Key risk factors for NECs include age > 40 years, extra-pancreatic origin and small-cell histology. EUS-guided biopsy is essential for early detection, risk stratification, and treatment planning of PHB-NETs. Clinicians should maintain a high index of suspicion for NECs in older patients with non-pancreatic lesions and small-cell histology to optimize management strategies.