The first case of combined pancreatic neuroendocrine tumour and neuroendocrine carcinoma.

Pancreatic neuroendocrine neoplasms are currently thought to originate from distinct progenitor cells that cannot differentiate into each other. We present the first reported case of a combined pancreatic neuroendocrine tumour and neuroendocrine carcinoma in a 58-year-old man who was investigated for abdominal pain and constipation. Imaging revealed a large left upper quadrant mass infiltrating the pancreatic body and tail, splenic hilum, and posterior stomach wall, with five hepatic metastases. This was treated with neoadjuvant and adjuvant chemotherapy, debulking surgery, and lutetium-177-DOTATATE peptide receptor radionuclide therapy. This case emphasises the importance of molecular imaging, meticulous microscopic examination, and multidisciplinary discussion for accurate diagnoses, improved prognostication, and efficacious treatment.