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This report describes a rare 71-year-old female with sequential, metachronous primary pancreatic neuroendocrine tumor (PanNET) and PDAC. PanNET stage IA was treated with Whipple procedure, followed one year later by completion pancreatectomy. Complications limited adjuvant therapy, yet sequential gemcitabine then irinotecan controlled hepatic progression for 12 months.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/metachronous-primary-pancreatic-neuroendocrine-tumor-and-adenocarcinoma-a-case-report/354272/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/metachronous-primary-pancreatic-neuroendocrine-tumor-and-adenocarcinoma-a-case-report/354272.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-27","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes this case metachronous rather than synchronous pancreatic tumors?","Question",{"text":112,"@type":113},"The neuroendocrine tumor and the later PDAC occur sequentially with an interval greater than 6 months, reported here as a 12-month interval.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the initial PanNET treated and what staging was reported?",{"text":117,"@type":113},"The patient underwent R0 pancreatoduodenectomy (Whipple procedure). Pathology confirmed a well-differentiated PanNET, stage IA (pT1N0, Ki-67 \u003C 3%).",{"name":119,"@type":110,"acceptedAnswer":120},"Why was adjuvant chemotherapy not possible after completion pancreatectomy?",{"text":121,"@type":113},"Postoperative complications, including reactive thrombocytosis and type 3c diabetes, precluded adjuvant chemotherapy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},354272,1790168128,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Cancer Reports  \nCASE REPORT  OPEN ACCESS   \nMetachronous Primary Pancreatic Neuroendocrine Tumor and Adenocarcinoma: A Case Report  \nAnastasia S. Fatyanova1 | Maria E. Kalinina1 | Dina F. Islamova1 | Igor O. Shchekoturov1 | Julia V. Lerner1 | Nadezhda A. Stashevskaya2 | Pavel Burko3 | Ilias Miltiadis4   \n1Sechenov University, Moscow, Russia | 2RUDN University, Moscow, Russia | 3Synergy University, Moscow, Russia | 4Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy  \nCorrespondence: Ilias Miltiadis ([ilias.miltiadis@you.unipa.it](ilias.miltiadis@you.unipa.it))  \nReceived: 11 November 2025 | Revised: 19 May 2026 | Accepted: 25 May 2026  \nABSTRACT  \nBackground: Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, with most patients presenting with advanced disease. Surgical resection remains the only potentially curative option, yet recurrence rates are high.  \nCase: We present a rare case of metachronous primary pancreatic neuroendocrine tumor (PanNET) and PDAC in a 71-year-old female. Initial management of stage IA PanNET (pT1N0M0) involved pancreatoduodenectomy (Whipple procedure) in 2022. One year later, the patient developed primary PDAC (pT2N1M0, stage IIB) in the remnant pancreas and was treated with completion pancreatectomy. Postoperative complications (reactive thrombocytosis and type 3c diabetes) precluded adjuvant chemotherapy. Subsequent hepatic progression was controlled for 12 months with first-line gemcitabine before progression necessitated second-line irinotecan. Conclusion: This case highlights the challenges of managing sequential primary pancreatic malignancies, the impact of total pancreatectomy complications on therapeutic options, and the potential for disease control with sequential systemic therapy even after aggressive recurrence.  \n1 | Introduction  \nPancreatic cancer is projected to become the second leading cause of cancer-related mortality worldwide by 2030 [1, 2]. Pancreatic ductal adenocarcinoma (PDAC) constitutes approximately 95% of cases and is frequently diagnosed at locally advanced or metastatic stages (> 80%), where systemic chemotherapy forms the cornerstone of management [3–5]. Surgical resection (partial or total pancreatectomy) offers the only potential for a cure in patients with localized disease, yet the 5-year survival rate remains poor (ranging from 0% to 33% on the basis of tumor size and stage)[6, 7]. Outcomes are influenced by factors such as margin status (R0 vs. R1), lymph node involvement, vascular invasion, and patient performance status [6, 8]. Despite advances, recurrence rates postresection are high, underscoring the need for effective adjuvant and metastatic therapies [9]. The occurrence of metachronous primary pancreatic malignancies of differing histologies (e.g., neuroendocrine tumor followed by adenocarcinoma) is  \nexceptionally rare and presents unique management challenges. Unlike synchronous “collision” tumors which occur simultaneously or within 6 months, metachronous tumors appear sequentially with an interval greater than 6 months. We report such a case with a 12-month interval, detailing the clinical course, therapeutic interventions, and outcomes.  \n2 | Case Report  \n2.1 | Initial Presentation and Diagnosis of PanNET (2022)  \nA 71-year-old female presented with acute pancreatitis (resolved conservatively) that had occurred 9 years prior, and was treated conservatively at her local hospital (Figure 1a) . In 2022, surveillance imaging revealed a 20 × 11 × 14 mm mass in the pancreatic head causing abrupt upstream pancreatic duct dilation (7 mm) .  \nThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \n© 2026 The Author(s). Cancer Reports published by Wiley Periodicals LLC.  \nCancer Reports, 2026; 9:e70595 1 of 10  \n[https://doi.org/10.1002/cnr","cbCaibRB4IKN2q0L","https://ap.wps.com/l/cbCaibRB4IKN2q0L","pdf",2508115,"English","# Introduction\n# Case Report\n## Initial Presentation and Diagnosis of PanNET (2022)\n## Treatment of PanNET\n## Diagnosis of Metachronous PDAC (2023)","[{\"question\":\"What makes this case metachronous rather than synchronous pancreatic tumors?\",\"answer\":\"The neuroendocrine tumor and the later PDAC occur sequentially with an interval greater than 6 months, reported here as a 12-month interval.\"},{\"question\":\"How was the initial PanNET treated and what staging was reported?\",\"answer\":\"The patient underwent R0 pancreatoduodenectomy (Whipple procedure). Pathology confirmed a well-differentiated PanNET, stage IA (pT1N0, Ki-67 \\u003c 3%).\"},{\"question\":\"Why was adjuvant chemotherapy not possible after completion pancreatectomy?\",\"answer\":\"Postoperative complications, including reactive thrombocytosis and type 3c diabetes, precluded adjuvant chemotherapy.\"}]","Metachronous Primary Pancreatic Neuroendocrine Tumor and Adenocarcinoma - A Case Report | PDF",1790109809,25]