To investigate the clinicopathological features, treatments and prognosis of liver metastases from pancreatic neuroendocrine neoplasms (pNENs).

Clinical data of 1 patient with liver metastases from pNENs admitted to Tianjin First Central Hospital in October 2019 were retrospectively analyzed. The 25-year-old male patient was admitted to hospital due to "intermittent abdominal pain for 3 years and yellow coloration of the skin and sclera for 1 year". Physical examination found severe yellow coloration of the skin and sclera, no tenderness, rebound pain or muscle tension of the whole abdomen, and the shifting dullness was positive. Laboratory test results showed that Hb was 90 g/L, ALB 33 g/L, ALT 73 U/L, AST 88 U/L, TB 343 μmol/L, DB 279 μmol/L, ALP 1 361 U/L, GGT 743 U/L, CA19-9 128 kU/L and neuron-specific enolase (NSE) 19.1 μg/L. Abdominal CT scan indicated a pancreatic head tumor with multiple nodules in the liver. PET-CT revealed irregular nodules with soft-tissue density in the pancreatic head complicated with multiple low-density liver metastases. The pathological findings of biopsy of pancreatic head and liver space-occupying lesions indicated pNENs. He was diagnosed with liver metastases from pNENs. The informed consent of this patient was obtained and the local ethical committee approval was received. After adequate preoperative preparations, combined liver-pancreas transplantation was performed on January 7, 2020.

Postoperative pathological examination showed intermediate-grade (G2) liver metastases from pNENs. Immunohistochemistry showed CgA (+), Syn (+), and Ki-67 index was approximately 10%. Immune induction therapy baliximab + methylprednisolone was given. Tacrolimus +mycophenolate mofetil + adrenocortical hormone were delivered to prevent rejection. The function of liver and pancreas grafts was properly recovered. During 13-month follow-up, multiple lymph node metastases in the left clavicle, pericardium, posterior pancreas and abdominal aorta were found by PET-CT. The signs of recurrence were noted. The function of liver and pancreas grafts was normal. The patient was treated with octreotide acetate-loaded microspheres consecutively and currently survived with tumors.

No specific manifestations can be found for liver metastases from pNENs, but abdominal pain and jaundice can be observed in most case. Elevated CA19-9 and NSE levels and positive CgA and Syn contribute to clinical diagnosis. Combined liver-pancreas transplantation can improve the quality of life of patients complicated with extensive liver metastases.