Incidental multifocal pancreatic neuroendocrine tumors: A rare synchronous conundrum with intra-ampullary and peri-ampullary adenocarcinoma.

We report a rare case of synchronous multifocal pancreatic neuroendocrine tumors (pNETs) discovered incidentally during histopathological examination of a pancreatic adenocarcinoma. A 65-year-old female patient with right upper abdominal pain, jaundice, and weight loss was diagnosed with a periampullary adenocarcinoma. Imaging revealed a soft tissue lesion in the periampullary region, and a Whipple procedure was performed. Histological examination identified a moderately differentiated pancreaticobiliary adenocarcinoma and multiple foci of well-differentiated neuroendocrine tumors (NETs). Immunohistochemistry confirmed distinct tumor types, with adenocarcinoma showing CK7 positivity and NET positive for synaptophysin, chromogranin, and low Ki-67. This case highlights the diagnostic challenge of synchronous malignancies and underscores the importance of thorough histopathologic evaluation.