Synchronous Pancreatic Head Well-Differentiated Neuroendocrine Tumor and Left Adrenal Composite Pheochromocytoma: A Rare Case with Successful Pancreaticoduodenectomy and Left Adrenalectomy

Abstract

Background: Synchronous pancreatic neuroendocrine neoplasms and adrenal tumors represent rare diagnostic and therapeutic challenges. Case Presentation: This study reports a 39-year-old woman presenting with vague abdominal pain and recurrent vomiting. Imaging (USG, CECT, MRCP) revealed a cystic solid lesion in the pancreatic head and a separate left adrenal mass. Tumor markers (CEA, CA 19-9) were normal. The patient underwent pancreaticoduodenectomy and left adrenalectomy with an uneventful postoperative course. Final histopathology confirmed a well-differentiated Grade 1 neuroendocrine tumor of the pancreatic head and a composite pheochromocytoma of the left adrenal gland. At 3-month follow-up, the patient remained asymptomatic and continued surveillance and endocrine evaluation. 18F-FDG PET/CECT demonstrated only mild postoperative inflammatory uptake in the surgical beds, with no evidence of residual, recurrent, or metastatic disease, supporting complete oncological resection and favorable early outcome. Conclusion: This case highlights the importance of multimodal imaging and surgical management in synchronous tumors and suggests consideration of genetic evaluation.